The research team, led by Atinuke G. Oyinbo and Saif Al Amin of the University of North Carolina at Chapel Hill Lineberger Comprehensive Cancer Center, defined emergency presentation as a cancer diagnosis preceded by a recent emergency department visit. They then split this group into two clinically distinct categories: emergency presentation inpatients, who were admitted to the hospital after their emergency visit, and emergency presentation outpatients, who were discharged with instructions for follow-up care. The numbers were stark. Overall, 37 percent of patients were diagnosed through involvement with the emergency department, with 30 percent falling into the inpatient category and 7 percent into the outpatient group. That means nearly one in three older adults with multiple myeloma was already sick enough to require hospitalization by the time the cancer was identified.

What makes this figure especially concerning is what emergency presentation typically signals for cancer outcomes. Previous research, including a large international study published in Lancet Oncology and a companion analysis of more than 929,000 Medicare beneficiaries with common cancers, has linked diagnosis through emergency admission to substantially higher short-term mortality. For a disease like multiple myeloma, which is often preceded by a detectable precursor state and can be identified with relatively simple blood tests, the high rate of emergency diagnosis suggests a systemic failure to catch the cancer earlier, when treatment is generally more effective and less punishing.

The study’s technical strength lies in its use of iteratively adjusted statistical models, which allowed the researchers to estimate the independent association of each patient-level factor with emergency diagnosis while accounting for the influence of all others. Through this approach, a consistent constellation of risk factors emerged. The oldest patients, women, and people from several racial and ethnic minority groups, including non-Hispanic Black, Hispanic, Asian American, and Native Hawaiian or Other Pacific Islander patients, were all more likely to be diagnosed through the emergency department. So were those who were unmarried, dually eligible for both Medicaid and Medicare, living in counties with the lowest socioeconomic status, residing in rural areas, or classified as frail using a claims-based frailty index. Higher healthcare utilization in the year before diagnosis also predicted emergency presentation, a finding that initially seems paradoxical but becomes clearer when the timeline is examined closely.

That timeline is where the study delivers its most provocative insight. The researchers compared symptom-related healthcare utilization between patients diagnosed through emergency presentation and those diagnosed through other routes in the year preceding diagnosis. Remarkably, the two groups were broadly comparable in how often they sought care for symptoms that could plausibly relate to myeloma during most of that year. But in the final month before diagnosis, utilization in the emergency presentation group spiked dramatically. This pattern suggests that many patients who ended up in emergency rooms were not avoiding the healthcare system altogether. They were seeing doctors, reporting symptoms, and undergoing evaluations, yet the underlying cancer was not recognized until they became acutely ill.

The biological explanation for this diagnostic blind spot lies in the nature of the disease itself. Multiple myeloma arises from plasma cells in the bone marrow and produces its damage through a constellation of nonspecific mechanisms: anemia causing fatigue, bone destruction causing pain, kidney impairment, elevated calcium, and increased susceptibility to infections. Each of these features can be attributed to far more common conditions in an aging population. A 76-year-old with back pain and tiredness is far more likely to be evaluated for degenerative joint disease or depression than for a plasma cell disorder. The median age of patients in this study was 76, an age at which multiple competing health problems routinely coexist, further muddying the diagnostic picture. Prior systematic reviews have quantified substantial delays between first symptoms and diagnosis in myeloma, and UK data from the Haematological Malignancy Research Network have documented similar patterns of unplanned diagnostic routes in this cancer.

The disparities identified in the study add a layer of health equity concern that extends beyond clinical medicine. Dual eligibility for Medicaid and Medicare serves as a proxy for low income, and its association with emergency diagnosis suggests that financial barriers to proactive care may push patients toward emergency departments as their default entry point. Rurality and low county socioeconomic status point to structural issues of access, including fewer primary care providers, longer travel distances, and limited availability of specialist referrals. The finding that non-Hispanic Black patients face elevated odds of emergency diagnosis is particularly significant given that Black Americans carry roughly twice the incidence of multiple myeloma compared with white Americans, a disparity rooted in both biology and healthcare access. Prior work has documented that Black patients with myeloma experience delays and disparities at multiple points along the diagnostic pathway, and this study confirms that the emergency department remains a disproportionate site of first diagnosis for this population.

Frailty emerged as another powerful predictor, and its role deserves careful interpretation. The claims-based frailty index used in the study captures accumulated deficits in health status, and frailer patients are both more likely to experience acute decompensation that lands them in the emergency room and more likely to have their myeloma symptoms attributed to general decline. There is also a practical dimension: frail older adults often depend on care partners to navigate appointments, communicate symptoms, and follow through on referrals, and research on the role of companions in oncology consultations suggests that the presence or absence of such support can meaningfully shape whether concerning findings get escalated. Unmarried status, which was independently associated with emergency diagnosis, may reflect the absence of that advocacy layer.

The study’s implications for policy and practice are concrete. Because the researchers found that symptom-related healthcare utilization was similar between emergency and non-emergency groups in the months before diagnosis, the problem appears to be not a lack of contact with the system but a failure to connect symptoms to the right diagnostic workup. This points toward interventions at the primary care level, including better use of blood tests such as serum protein electrophoresis when older patients present with unexplained anemia, bone pain, or kidney dysfunction. It also supports the development of rapid diagnostic clinics for suspected cancer, models that have been piloted at several US cancer centers and that aim to compress the time from suspicious findings to definitive workup. The precursor state of myeloma, monoclonal gammopathy of undetermined significance, is detectable in a meaningful fraction of the older population, and large screening efforts such as the iStopMM study in Iceland have demonstrated that population-level identification of this precursor is feasible, though the question of whether such screening should be broadly implemented remains open.

What the SEER-Medicare data ultimately reveal is a diagnosis arriving too late for a preventable share of patients, and a healthcare system that touches these patients repeatedly before the moment of recognition. The 37 percent emergency presentation rate for multiple myeloma stands as a benchmark against which future interventions can be measured. Reducing it will require clinicians to lower their threshold for ordering the simple tests that unmask this cancer, health systems to build pathways that route suspicious findings quickly out of the emergency department and into definitive care, and policymakers to address the socioeconomic and geographic barriers that make the emergency room the only door some patients feel they can walk through. Until then, the great imitator will continue to announce itself in the least forgiving setting imaginable.

Subject of Research: Emergency department involvement in the diagnosis of multiple myeloma among older US adults

Article Title: Emergency diagnosis of multiple myeloma: a SEER-Medicare study

Article References: Oyinbo, A. G., Al Amin, S., LeBlanc, M. R., Keene, S. A., Hinton, S. P., Kurian, A. W., Pruitt, S. L., Pettit, N., Mullins, M. A., Lyratzopoulos, G., & Thompson, C. A. (2026). Emergency diagnosis of multiple myeloma: a SEER-Medicare study. Cancer Causes & Control, 37(10), Article 175. https://doi.org/10.1007/s10552-026-02263-9

Image Credits: AI Generated

DOI: 10.1007/s10552-026-02263-9

Keywords: multiple myeloma, emergency presentation, SEER-Medicare, cancer diagnosis, health disparities, older adults, emergency department, diagnostic delay, healthcare utilization, frailty, plasma cell disorder, cancer epidemiology