Background International studies have highlighted the poor outcomes associated with cancer diagnosis following an emergency presentation (EP) to hospital. This study aims at assessing the rate of cancer patients newly referred to the Greater Paris University Hospitals (APHP) after an EP and the impact of EP on patient survival across various types of cancer. Methods A retrospective multicenter cohort study was conducted using the data warehouse of APHP. Consecutive patients newly referred with breast, lung, colon, rectum or pancreatic cancer between January 2019 and June 2022 were identified using claims data (ICD-10 codes). Comparative analyses between EP (diagnosis confirmed ≤30 days after emergency admission) and non-EP patients comprised in-hospital imaging, initial tumor staging from baseline PET/CT and CT-scan reports, and surgical treatment. Multivariable logistic regression was used to assess EP prevalence and its association with patient survival, adjusting for age, gender, diagnostic year (considering potential impacts of the COVID-19 pandemic), and cancer site. A Cox model was used to assess association of EP with survival, adjusting for the same factors and baseline metastatic status. Results The final cohort comprised 25,845 patients with 3,960 (15.3%) newly referred after an EP. EP patients exhibited higher rates of metastatic cancer (59% vs. 45%) and in-hospital imaging (53% vs. 31%), lower surgery rates (except for colon cancer patients) (18% vs 41%), and a higher risk to die within a year of diagnosis (49% vs 16%). Lung and pancreatic cancers were more frequent in EP than other cancer sites (20% and 23% respectively). The proportion of EP and non-EP patients was comparable during and after the COVID-19 pandemic, except for lung cancer. In the multivariable analysis, EP was strongly associated with age only for patients above 80 years of age (odds ratio: 3.1, 95% CI; 2.6-3.6). After adjusting for age and cancer site, patient mortality rate increased with EP referral (HR: 2.7, 95% CI 2.5-2.8). Conclusions Emergency presentation in a university hospital is a marker of poor outcome among newly referred cancer patients. Better coordination between hospitals and ambulatory health care networks is needed.