We read with great interest the article by Pettit et al. regarding the importance of the safety-net healthcare system in prompt diagnosis and management of lung cancer patients [ ]. We commend the authors for adeptly elucidating the prevalence and severity of acutely presenting lung cancer and emphasizing the importance of promptly detecting and appropriately managing the disease within an emergency setting. However, additional factors may be considered to better apply the author’s findings to clinical settings.

First, the authors did not consider the causes of death nor follow-up periods while considering mortality. Multiple factors could alter the mortality rate in patients with lung cancer, including its subtypes, clinical presentations, and complications accompanied by treatments. The authors did not discuss the types of lung cancer which can significantly influence the results [ ]. More detailed information regarding prognosis would provide further insight, especially considering that the importance of emergency department (ED) in early diagnosis was emphasized. The present study included a large proportion of patients at stage II or III, the class of patients benefiting the most from early intervention.

In addition, consideration regarding the definition of emergency presentation (EP) is needed. While we agree with the authors on the significance of EPs, it is imperative to provide explicit criteria for EPs to translate the author’s findings to clinical practice. For example, lung cancer can manifest in ED with symptoms due to metastasis, such as bone pain and neurological symptoms, especially in stage IV patients, accounting for 46% of patients in this study. Additionally, regardless of presentation type, patients arriving in the emergency department may face risks unrelated to their lung cancer diagnosis. A comprehensive discussion of these potential confounding factors is crucial.

To further enrich the author’s findings on early detection and management of lung cancer, we suggest analysis based on factors including patients’ income and health literacy. The National Health and Nutrition Examination Survey demonstrated a strong association between cancer prevalence and socioeconomic strata in the US. Patients’ income and health literacy may lead to better frequency of clinic visits and early detection of lung cancer [ ]. Furthermore, it is imperative to consider cost-effectiveness to enhance the applicability of the author’s points. The reduction of unnecessary medical examinations is currently a topic of discussion, and information on the potential overdiagnosis of benign conditions would be instrumental in striking a necessary balance.

Overall, we congratulate the authors on conducting this study and believe that further consideration of the aforementioned concerns could make this study more applicable in clinical settings.

References

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