Factors associated with emergency-onset diagnosis, time to treatment and type of treatment in colorectal cancer patients in Norway

Abstract

Background International differences in survival among colorectal cancer (CRC) patients may partly be explained by differences in emergency presentations (EP), waiting times and access to treatment. Methods CRC patients registered in 2015–2016 at the Cancer Registry of Norway were linked with the Norwegian Patient Registry and Statistics Norway. Multivariable logistic regressions analysed the odds of an EP and access to surgery, radiotherapy and systemic anticancer treatment (SACT). Multivariable quantile regression analysed time from diagnosis to treatment. Results Of 8216 CRC patients 29.2% had an EP before diagnosis, of which 81.4% were admitted to hospital with a malignancy-related condition. Higher age, more advanced stage, more comorbidities and colon cancer were associated with increased odds of an EP (p < 0.001). One-year mortality was 87% higher among EP patients (HR=1.87, 95%CI:1.75–2.02). Being married or high income was associated with 30% reduced odds of an EP (p < 0.001). Older age was significantly associated with increased waiting time to treatment (p < 0.001). Region of residence was significantly associated with waiting time and access to treatment (p < 0.001). Male (OR = 1.30, 95%CI:1.03,1.64) or married (OR = 1.39, 95%CI:1.09,1.77) colon cancer patients had an increased odds of SACT. High income rectal cancer patients had an increased odds (OR = 1.48, 95%CI:1.03,2.13) of surgery. Conclusion Patients who were older, with advanced disease or more comorbidities were more likely to have an emergency-onset diagnosis and less likely to receive treatment. Income was not associated with waiting time or access to treatment among CRC patients, but was associated with the likelihood of surgery among rectal cancer patients.

Impact of two waves of Sars‐Cov2 outbreak on the number, clinical presentation, care trajectories and survival of patients newly referred for a colorectal cancer: A French multicentric cohort study from a large group of university hospitals

“…Aside from initial tumor stage, the emergency with which primary tumor is resected could be a factor to explain the lower OS. Published studies demonstrated that elective surgeries were associated with better patient' clinical outcomes than emergency CRC primary tumor resections, even with local complications 36‐38 . Our results showed that the rate of elective primary tumor resections reached around 70% over time and did not decrease after 2020.…”

“…Published studies demonstrated that elective surgeries were associated with better patient' clinical outcomes than emergency CRC primary tumor resections, even with local complications. [36][37][38] Our results showed that the rate of elective primary tumor resections reached around 70% over time and did not decrease after 2020. A study in Australia and New Zealand and a single-site Japanese study found a significantly larger share of urgent CRC cases during the pandemic.…”

Risk factors and prognostic implications of diagnosis of cancer within 30 days after an emergency hospital admission (emergency presentation): an International Cancer Benchmarking Partnership (ICBP) population-based study

“…However, strong associations between emergency presentation and mortality prevail even after adjustment for comorbidity. 15 , 21 , 27 , 28 Rural or urban patient residence might also be associated with differential risk of emergency presentation. 29 Another possible confounder (eg, of associations with age) is screening detection status, particularly in colorectal cancer, although there were no suitable data to enable such an analysis to be done.…”

Acute healthcare utilization in end-of-life among Swedish brain tumor patients – a population based register study

“…Inequality in cancer care, especially expensive treatments, has previously been described in relation to sex, age and SES, including educational level and marital status [ 28 – 30 ]. Moreover, cancer patients with lower SES have worse survival prospects [ 31 ].…”