Causes and outcomes of emergency presentation of rectal cancer

Abstract

Emergency presentation of rectal cancer carries a relatively poor prognosis, but the roles and interactions of causative factors remain unclear. We describe an innovative statistical approach which distinguishes between direct and indirect effects of a number of contextual, patient and tumour factors on emergency presentation and outcome of rectal cancer. All patients diagnosed with rectal cancer in Ireland 2004-2008 were included. Registry information, linked to hospital discharge data, provided data on patient demographics, comorbidity and health insurance; population density and deprivation of area of residence; tumour type, site, grade and stage; treatment type and optimality; and emergency presentation and hospital caseload. Data were modelled using a structural equation model with a discrete-time survival outcome, allowing us to estimate direct and mediated effects of the above factors on hazard, and their inter-relationships. Two thousand seven hundred and fifty patients were included in the analysis. Around 12% had emergency presentations, which increased hazard by 80%. Affluence, private patient status and being married reduced hazard indirectly by reducing emergency presentation. Older patients had more emergency presentations, while married patients, private patients or those living in less deprived areas had fewer than expected. Patients presenting as an emergency were less likely to receive optimal treatment or to have this in a high caseload hospital. Apart from stage, emergency admission was the strongest determinant of poor survival. The factors contributing to emergency admission in this study are similar to those associated with diagnostic delay. The socio-economic gradient found suggests that patient education and earlier access to endoscopic investigation for public patients could reduce emergency presentation.

Factors influencing access to education, decision making, and receipt of preferred dialysis modality in unplanned dialysis start patients

“…In oncology, a study of colorectal cancer patients26 showed that inadequate functional health literacy was more frequently observed in patients with age over 65 years. An interesting finding was observed in a large study of 2,750 colorectal cancer patients in Ireland:27 older patients were more likely to have an emergency presentation, analogous to UPS in that study, and emergency patients had worse clinical outcomes. Age is also relevant in determining the focus of educational areas for oncology patients,16 and delivering education to more elderly patients is feasible.…”

Disparities in outcomes among patients diagnosed with cancer associated with emergency department visits

“…Tumor specific biology has been linked to increased associations with emergent presentations, with more rapidly, aggressive tumors being more likely to be diagnosed emergently. 35 Regardless, we made an inference that being diagnosed with cancer within 6 months of a recorded ED visit, meant those ED physicians had an opportunity to diagnose asymptomatic cancer, if that ED visit wasn’t directly related to the presentation of emergent cancer diagnosis. Further, no knowledge is known about previous screenings and primary care follow up, thus no inference can be made to know whether or not screening may have reduced the likelihood of the found associations.…”

The clinical application value of MR diffusion-weighted imaging in the diagnosis of rectal cancer

“…According to epidemiological studies, low residue diet, high fat diet, benign adenoma (papillary adenoma and familial multiple polyposis) cancer are all risk factors in rectal cancer. [10,11] The pathogenesis of rectal cancer is usually considered to be influenced by both the diet and environment and its mechanism has not yet been completely determined.…”