In our study, there was a noticeable higher incidence of female patients among those referred by EMS HCB. A large study conducted in the USA by the Centers for Disease Control and Prevention (CDC) also found a higher incidence of cancer in females.[11] However, other studies suggest a higher prevalence of male patients with cancer presenting to Emergency Departments (ED).[12] According to the WHO, there are more men suffering from various forms of cancers globally.[13] We believe that differences in gender distribution may vary at the national level and even at the level of smaller organizational units within institutions or districts within a country, due the varying distributions of malignant diseases within specific geographic areas, as well as population differences.

In our study, 5.23% of patients who contacted EMS HCB during the observation period had a malignant disease. According to data available in literature/research database, this percentage ranges from about 0.8%to as high as 9%.[14–20]

The age distribution in our study shows a higher mean and median age for male patients. Isikber and colleagues observed the same trend in their study, with the mean age for female patients being 57.5 y and 63.3 y for male patients.[21] According to Said and colleagues, the average age of oncology patients presenting to the ED was 53.7 y.[22] Malignant diseases are most common in the population aged 60 and older, according to the National Cancer Institute (NCI).[23] The same source reports that the median age at which cancer is diagnosed is 66 y. Although our study does not analyze patients’ age at the time of the diagnosis of cancer the median age for our patients with malignancies is also 66 y. Grewal and colleagues report the same median age.[24]

According to data from research databases, EOC is less common, accounting for about 22% of cases.[25] Current research also shows that EOC is more frequent in males.[26] The Institute of Public Health of Serbia reports that 9% of all malignancies found in men, in Serbia, are EOC, while the percentage is 15.6% in women respectively.[4] According to the same source, in Serbia, the mortality rate from malignant diseases in men under 50 years old is 31.5% of total number of deaths from cancer, whereas for women this percentage is 32%. The given data are from 2019, so an analysis for the period from 2020 onward is much needed.

The most prescribed therapy was corticosteroids. Our teams used dexamethasone and methylprednisolone. Pain medications were shown to be the second most frequently prescribed therapy. Literature data suggest that the most prescribed group of drugs for oncology patients in the ED is analgesics.[27] According to the same source, antiemetics were administered to 47.6% of patients with malignancies who presented to the ED. While corticosteroids play a key role in the treatment of oncology patients, they also come with a range of side effects, requiring caution in their use.[28] About one-fifth of the patients for whom EMS HCB intervened due to cancer and cancer-related illness were referred to a hospital for further examination and/or treatment. While this data is not directly comparable with the data found in literature, it might be somewhat analogous to hospital admissions in studies analyzing oncology patients’ presentation to emergency departments at hospitals. For instance, Legramante and colleagues found that over 70% of patients were admitted to hospital after an initial emergency department examination.[29] Similar findings have been reported by other researchers.[30]

The presentation of interventions by month attempts to establish an annual pattern; however this requires further long-term analysis.

There are several limitations to this study. Firstly, it pertains to field teams, which in Serbia consist of a medical doctor-who may be either a general practitioner or a specialist-a medical technician and an ambulance driver. The study does not analyze oncology patient presentations to hospitals. Additionally, the presented results are based on a population of approximately 25,000 residents covered by HCB and its EMS, so the findings cannot be generalized to other parts of Belgrade and Serbia. Moreover, our sample is not representative, but we believe it may serve as a basis for further research and future comparisons of data in the field of Emergency Medical Care (EMC) for oncology patients. The organization of EMS HCB may also, at least partially, account for the limited applicability of the data obtained through this study. Lastly, another limitation is the small number of studies addressing this issue in Serbia.