Diagnosis Setting and Colorectal Cancer Outcomes: The Impact of Cancer Diagnosis in the Emergency Department.
Colorectal neoplasms
Emergency service
Hospital
Neoplasms/diagnosis
Journal
The Journal of surgical research
ISSN: 1095-8673
Titre abrégé: J Surg Res
Pays: United States
ID NLM: 0376340
Informations de publication
Date de publication:
11 2020
11 2020
Historique:
received:
14
11
2019
revised:
11
03
2020
accepted:
03
05
2020
pubmed:
21
6
2020
medline:
1
12
2020
entrez:
21
6
2020
Statut:
ppublish
Résumé
The rate of diagnosis of colorectal cancer (CRC) in the emergency department (ED), its characteristics, and its effect on outcomes have been poorly described. Chart review was conducted to identify presenting clinical setting leading to diagnosis, symptoms, and history of colonoscopy for patients diagnosed with CRC at a single institution from 2012-2014. Patients diagnosed with CRC as a result of an ED visit (EDDx) were compared with those diagnosed after presentation to other settings (non-EDDx). Of 638 patients meeting inclusion criteria, 271 (42.4%) were EDDx patients. These patients were more likely to be older than 80 y (29.89% versus 19.35%), have Medicare (59.78% versus 42.78%) or Medicaid (23.62% versus 12.81%) insurance, have stage IV cancer (45.02% versus 18.26%), and were symptomatic at the time of presentation (94.83% versus 64.03%). EDDx patients were less likely to ever have had a colonoscopy (21.77% versus 41.69%). In a model adjusted for patient demographics, cancer stage, presence of symptoms, and history of prior colonoscopy, EDDx was associated with increased mortality (hazard ratio, 1.89; 95% confidence interval, 1.3-2.8). On stratifying survival by stage, it was found that for all stages, EDDx was associated with decreased survival. More than 40% of patients with CRC received their diagnosis through the ED. EDDx was associated with a nearly twofold mortality risk increase. EDDx should be considered a marker of poor outcomes for CRC and may be related to unaccounted patient-level or systems-level factors. Efforts should be made to identify modifiable risks of cancer diagnosis in the ED to improve cancer outcomes.
Sections du résumé
BACKGROUND
The rate of diagnosis of colorectal cancer (CRC) in the emergency department (ED), its characteristics, and its effect on outcomes have been poorly described.
MATERIALS AND METHODS
Chart review was conducted to identify presenting clinical setting leading to diagnosis, symptoms, and history of colonoscopy for patients diagnosed with CRC at a single institution from 2012-2014. Patients diagnosed with CRC as a result of an ED visit (EDDx) were compared with those diagnosed after presentation to other settings (non-EDDx).
RESULTS
Of 638 patients meeting inclusion criteria, 271 (42.4%) were EDDx patients. These patients were more likely to be older than 80 y (29.89% versus 19.35%), have Medicare (59.78% versus 42.78%) or Medicaid (23.62% versus 12.81%) insurance, have stage IV cancer (45.02% versus 18.26%), and were symptomatic at the time of presentation (94.83% versus 64.03%). EDDx patients were less likely to ever have had a colonoscopy (21.77% versus 41.69%). In a model adjusted for patient demographics, cancer stage, presence of symptoms, and history of prior colonoscopy, EDDx was associated with increased mortality (hazard ratio, 1.89; 95% confidence interval, 1.3-2.8). On stratifying survival by stage, it was found that for all stages, EDDx was associated with decreased survival.
CONCLUSIONS
More than 40% of patients with CRC received their diagnosis through the ED. EDDx was associated with a nearly twofold mortality risk increase. EDDx should be considered a marker of poor outcomes for CRC and may be related to unaccounted patient-level or systems-level factors. Efforts should be made to identify modifiable risks of cancer diagnosis in the ED to improve cancer outcomes.
Identifiants
pubmed: 32563008
pii: S0022-4804(20)30265-1
doi: 10.1016/j.jss.2020.05.005
pmc: PMC8029600
mid: NIHMS1594431
pii:
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
164-171Subventions
Organisme : NCI NIH HHS
ID : K12 CA132783
Pays : United States
Informations de copyright
Copyright © 2020 Elsevier Inc. All rights reserved.
Références
Surgery. 2017 Jun;161(6):1609-1618
pubmed: 28237645
BMC Health Serv Res. 2013 Aug 14;13:308
pubmed: 23941140
Aliment Pharmacol Ther. 2008 Nov 1;28(9):1166-74
pubmed: 18691351
Dig Dis Sci. 2015 Mar;60(3):681-91
pubmed: 25740556
Br J Cancer. 2012 Oct 9;107(8):1220-6
pubmed: 22996611
N Engl J Med. 2013 Sep 19;369(12):1095-105
pubmed: 24047059
BMJ. 2010 Jan 14;340:b5479
pubmed: 20075152
Am J Emerg Med. 2012 Feb;30(2):283-92
pubmed: 21247723
BMJ Open. 2015 Apr 02;5(4):e006965
pubmed: 25838506
Ann Surg Oncol. 2007 Mar;14(3):1099-104
pubmed: 17211732
CA Cancer J Clin. 2008 May-Jun;58(3):130-60
pubmed: 18322143
Am J Prev Med. 2010 May;38(5):508-16
pubmed: 20409499
CA Cancer J Clin. 2018 Jul;68(4):250-281
pubmed: 29846947
J Trauma Acute Care Surg. 2015 Sep;79(3):399-406
pubmed: 26307872
Int Surg. 2015 Jan;100(1):77-86
pubmed: 25594643
Am J Emerg Med. 2013 Apr;31(4):646-50
pubmed: 23380092
Fam Pract. 2006 Feb;23(1):15-9
pubmed: 16286462
Am J Surg. 2018 Aug;216(2):286-292
pubmed: 29108643
Acad Med. 2004 Dec;79(12):1154-61
pubmed: 15563649
Am J Surg. 2015 Feb;209(2):246-53
pubmed: 25457246
CA Cancer J Clin. 2007 Nov-Dec;57(6):354-66
pubmed: 17989130