Risk factors for emergency presentation with lung and colorectal cancers: a systematic review

Mitchell, Elizabeth; Pickwell-Smith, Benjamin; Macleod, Una

doi:10.1136/bmjopen-2014-006965

Cited by 53 publications

(50 citation statements)

References 25 publications

(81 reference statements)

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“…There is inconsistency in published studies as to whether a change in bowel habit, diarrhoea or weight loss are associated with an emergency diagnosis, perhaps due to variation in the definition of these symptoms, while per rectal bleeding and anaemia seem to be protective . The symptoms deemed relevant in our study were agreed by the authors and have previously been used in other studies to determine intervals from presentation to diagnosis .…”

Section: Discussionmentioning

confidence: 90%

“…In this national population‐based study we hypothesize that differences in presenting symptoms make delays in referral and emergency diagnoses more common in young patients (defined as those under the age of 50) than in older ones. An improved understanding of differences between age groups may reduce the rate of emergency diagnoses, with a subsequent improvement in stage and survival .…”

Section: Introductionmentioning

confidence: 99%

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Colorectal cancer patients under the age of 50 experience delays in primary care leading to emergency diagnoses: a population‐based study

et al. 2019

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Aim The incidence of colorectal cancer in the under 50s is increasing. In this national population‐based study we aim to show that missed opportunities for diagnosis in primary care are leading to referral delays and emergency diagnoses in young patients. Method We compared the interval before diagnosis, presenting symptom(s) and the odds ratio (OR) of an emergency diagnosis for those under the age of 50 with older patients sourced from the cancer registry with linkage to a national database of primary‐care records. Results The study included 7315 patients, of whom 508 (6.9%) were aged under 50 years, 1168 (16.0%) were aged 50–59, 2294 (31.4%) were aged 60–69 and 3345 (45.7%) were aged 70–79 years. Young patients were more likely to present with abdominal pain and via an emergency, and had the lowest percentage of early stage cancer. They experienced a longer interval between referral and diagnosis (12.5 days) than those aged 60–69, reflecting the higher proportion of referrals via the nonurgent pathway (33.3%). The OR of an emergency diagnosis did not differ with age if a red‐flag symptom was noted at presentation, but increased significantly for young patients if the symptom was nonspecific. Conclusion Young patients present to primary care with symptoms outside the national referral guidelines, increasing the likelihood of an emergency diagnosis.

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Section: Discussionmentioning

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Colorectal cancer patients under the age of 50 experience delays in primary care leading to emergency diagnoses: a population‐based study

et al. 2019

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“…On the other hand, 30% of emergency surgery was performed among older advanced-stage CRC patients with dementia. It has been shown that CRC diagnosed after a hospital emergency admission is more likely associated with older and more deprived individuals [35,36]. Recently, a study showed that 18% of CRC cases that were diagnosed as emergency cases had "red flag" symptoms, indicating the disease could have been identified earlier [30].…”

Section: Discussionmentioning

confidence: 99%

The pattern of Comorbidities and Associated Risk Factors among Colorectal Cancer Patients in Spain: CoMCoR study

Luque-Fernandez

Redondo‐Sánchez

Rodríguez‐Barranco

et al. 2019

Preprint

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Colorectal cancer is the second most frequently diagnosed cancer in Spain. Cancer treatment and outcomes can be influenced by tumor characteristics, patient general health status and comorbidities. Numerous studies have analyzed the influence of comorbidity on cancer outcomes, but limited information is available regarding the frequency and distribution of comorbidities in colorectal cancer patients, particularly elderly ones, in the Spanish population.We developed a population-based high-resolution cohort study of all incident colorectal cancer cases diagnosed in Spain in 2011 to describe the frequency and distribution of comorbidities, as well as tumor and healthcare factors. We then characterized risk factors associated with the most prevalent comorbidities, as well as dementia and multimorbidity, and developed an interactive web application to visualize our findings. The most common comorbidities were diabetes (23.6%), chronic obstructive pulmonary disease (17.2%), and congestive heart failure (14.5%).Dementia was the most common comorbidity among patients aged ≥ 75 years. Patients with dementia had a 30% higher prevalence of being diagnosed at stage IV and the highest prevalence of emergency hospital admission after colorectal cancer diagnosis (33%). Colorectal cancer patients with dementia were nearly three times more likely to not be offered surgical treatment.Age ≥ 75 years, obesity, male sex, being a current smoker, having surgery more than 60 days after cancer diagnosis, and not being offered surgical treatment were associated with a higher risk of multimorbidity. Patients with multimorbidity aged ≥ 75 years showed a higher prevalence of hospital emergency admission followed by surgery the same day of the admission (37%). We found a consistent pattern in the distribution and frequency of comorbidities and multimorbidity among colorectal cancer patients. The high frequency of stage IV diagnosis among patients with 7 1 7

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“…6,11 This is of particular concern for cancer, where one in five cancers are diagnosed through emergency presentation in England [12][13][14] and diagnoses through emergency much higher among lower SES groups. [15][16][17] This greatly impacts patients' survival, and the types of care they can receive.…”

Section: Introductionmentioning

confidence: 99%

Disparities In Cancer Care And Costs At The End Of Life: Evidence From England’s National Health Service

Walsh

Laudicella

2017

Health Affairs

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In universal health care systems such as the English National Health Service, equality of access is a core principle, and health care is free at the point of delivery. However, even within a universal system, disparities in care and costs exist along a socioeconomic gradient. Little is known about socioeconomic disparities at the end of life and how they affect health care costs. This study examines disparities in end-of-life treatment costs for cancer patients in England. Analyzing data on over 250,000 colorectal, breast, prostate, and lung cancer patients from multiple national databases, we found evidence illustrating that disparities are driven largely by the greater use of emergency inpatient care among patients of lower socioeconomic status. Even within a system with free health care, differences in the use of care create disparities in cancer costs. While further studies of these barriers is required, our research suggests that disparities may be reduced through better management of needs through the use of less expensive and more effective health care settings and treatments.

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Risk factors for emergency presentation with lung and colorectal cancers: a systematic review

Cited by 53 publications

References 25 publications

Colorectal cancer patients under the age of 50 experience delays in primary care leading to emergency diagnoses: a population‐based study

Colorectal cancer patients under the age of 50 experience delays in primary care leading to emergency diagnoses: a population‐based study

The pattern of Comorbidities and Associated Risk Factors among Colorectal Cancer Patients in Spain: CoMCoR study

Disparities In Cancer Care And Costs At The End Of Life: Evidence From England’s National Health Service

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