Emergency diagnosis of multiple myeloma: A SEER-Medicare study.

166 Background: A lack of screening tests and nonspecific presenting symptoms make multiple myeloma (MM) one of the most difficult cancers to diagnose, increasing the risk of late and emergent diagnosis. Studies outside the US report that MM patients diagnosed with emergency department (ED) involvement have worse survival compared to other patients. However, no prior studies have reported on ED diagnosis of MM in the U.S. Patients presenting to the ED may be admitted or discharged for outpatient follow up, representing distinctive diagnostic care pathways. In this study, we estimate the prevalence of “emergency presentation” (EP) for MM and explore associated patient characteristics. Methods: We studied SEER-Medicare beneficiaries with a diagnosis of MM (2008-2017). Emergency presentation (EP) was defined as diagnosis preceded by a recent ED visit subclassified as: inpatient (EP-IP) patients who were admitted for diagnosis and outpatient (EP-OP) patients who were discharged for outpatient diagnostic care. We examined differences in EP status by patient characteristics and used regression to estimate prevalence ratios (PRs) for EP-IP or EP-OP (vs. Non-EP) adjusted for patient characteristics and recent healthcare utilization. Results: Among 20,437 patients, 52% were male, 75% non-Hispanic White (NHW), and median age was 76. Overall, 36% were diagnosed through the ED (EP-IP: 29%; EP-OP: 7%). Older age was associated with increased EP, but only among the oldest patients with prevalence ratios (PR) for EP-IP (PR: 1.10; 95% CI: 1.03–1.17) and EP-OP (PR: 1.18; 1.00–1.38) for ≥85 vs 66–69 years old. Female sex was associated with increased EP-OP (PR: 1.17; 1.05–1.29). Non-Hispanic Black (PR: 1.13; 1.07–1.19), Hispanic (PR: 1.09; 1.01–1.18), and Asian American (PR: 1.13; 1.01–1.26) race were associated with EP-IP (vs. NHW) but no race associations were observed for EP-OP. Compared to metropolitan areas, urban non-metro (PR:1.53; 1.36-1.73) and rural residence (PR: 1.61; 1.19–2.18) was associated with substantially increased EP-OP. We also observed a significant increasing trend in the prevalence of EP-OP over the study period. Conclusions: More than a third of older US adults with MM are diagnosed through ED, with apparently rising rates. Advanced age, non-white race, female sex, and rural residence increase the likelihood of EP. These results suggest missed opportunities for earlier diagnosis in ambulatory settings and underscore the need for more research on early detection and diagnosis of MM.