Diagnosis Setting and Colorectal Cancer Outcomes: The Impact of Cancer Diagnosis in the Emergency Department

Weithorn, David; Arientyl, Vanessa; Solsky, Ian; Umadat, Goyal; Levine, Rebecca; Rapkin, Bruce D.; Leider, Jason; In, Haejin

doi:10.1016/j.jss.2020.05.005

Cited by 18 publications

(23 citation statements)

References 22 publications

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“…This study aimed to determine the influence of the COVID-19 pandemic on the stage and mode of presentation of patients with CRC at our Trust. Our study's main conclusions were as follows: (1) the number of CRC patients that presented as an emergency increased during the COVID-19 pandemic (03/2020 to 02/2021) compared with the previous three years; (2) locally advanced (T4) and metastatic (M1) diseases' percentages increased during the coronavirus widespread. Shinkwin et al reported similar results with increasing numbers of CRC emergency presentations and T4 stages during the first wave of the 2020 lockdown [13].…”

Section: Discussionmentioning

confidence: 81%

“…Colorectal cancer (CRC) is the fourth commonest cancer in the United Kingdom but has the second lowest five-year survival rate, after lung cancer [ 1 ]. Early detection significantly improves the prognosis [ 2 ]. Thus, one of the NHS’s key ambitions in the long-term plan (published January 2019) is that by 2028, 75% of people with cancer will be diagnosed at an early stage (stage one or two) [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

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Impact of COVID-19 on the Mode of Presentation and Stage at Diagnosis of Colorectal Cancer

Alrahawy¹,

Johnson²,

Aker³

et al. 2022

Cureus

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Aim: This study compares the stage at the presentation of patients with colorectal cancer (CRC) before and after introducing COVID-19 restrictions and the mode of presentation.Methods: This is a retrospective cohort study comparing the incidence of CRC, TNM stage and mode of presentation in the pre-COVID and COVID cohorts at a single UK Trust. All patients discussed at the CRC multidisciplinary team (MDT) from March 2017 to March 2021 were included and split into two cohorts; the pre-COVID group from 01/03/2017 to 29/02/2020 and the COVID group from 01/03/2020 to 28/02/2021. Percentages were used for descriptive statistics. Student's t-test was used for the comparison of demographic variables. Chi-squared test was used for the difference analysis for the categorical data, such as TNM and mode of presentation. P value ≤0.05 was significant.Results: In total, 1373 patients were diagnosed with CRC during the period from March 2017 to March 2021. The pre-COVID group (2017-2020) included 1104 CRC patients, compared to 269 patients in the COVID one (2020-2021). The mean age was higher in the pre-COVID group (p = 0.001). There was a statistically significant increase in the proportion of cases presenting with T4 disease (p = 0.023) and metastatic disease (p = 0.032) in the COVID group compared to the pre-COVID group. There was also a significant increase in the rate of emergency presentations (p < 0.0001). Conclusion:We observed a statistically significant increase in rates of locally advanced (T4) and metastatic (distant) CRC in patients presenting after introducing the COVID-19 lockdown. There was also an increase in emergency presentations. There was no observed difference in nodal status. This may reflect disruption to cancer diagnostic services and the reluctance of patients to access medical care during a pandemic, particularly the elderly.

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Section: Discussionmentioning

confidence: 81%

Section: Introductionmentioning

confidence: 99%

Impact of COVID-19 on the Mode of Presentation and Stage at Diagnosis of Colorectal Cancer

Alrahawy¹,

Johnson²,

Aker³

et al. 2022

Cureus

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“…Patients with an ED visit near a colorectal cancer or lung cancer diagnosis were more likely to be diagnosed at a later stage compared with patients diagnosed in other settings 47 . Weithorn et al reported on colorectal cancer ED‐associated initial diagnoses compared to non‐ED diagnoses and found that ED‐associated initial diagnoses were associated with increased mortality (HR: 1.89, 95% CI: 1.3–2.8), even when stratifying survival by stage 49 . Sikka et al and Weithorn et al found that colorectal cancer patients diagnosed through the ED were older with more comorbidities 47–49 .…”

Section: Resultsmentioning

confidence: 99%

“…The studies found that 12–32% of cancer diagnoses occurred through the ED. 14 , 41 Cancer diagnosis pathways varied by cancer type; for example, lung cancers diagnosed through an ED ranged from 10 to 57% 14 , 42 , 43 , 44 , 45 , 46 while colorectal cancer diagnosed through an ED ranged from 15 to 42% 14 , 47 , 48 , 49 (Table 4 ).…”

Section: Resultsmentioning

confidence: 99%

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Diagnosis of cancer in the Emergency Department: A scoping review

et al. 2023

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Background The Emergency Department (ED) plays a key role in the identification and care of acute medical conditions, including cancer. In this scoping review, we aimed to determine the role of the ED in the acute diagnosis of cancer. Methods We conducted a scoping review of articles according to Preferred Reporting Items for Systematic Review and Meta‐Analyses (PRISMA) using PubMed and Google Scholar. We screened studies of adults with a new diagnosis of cancer in the ED. We included randomized control trials, prospective, retrospective, and cross‐sectional observational studies, and case reports published in English since 2000. We grouped the articles into categories based on their objectives and findings. Results Of the 4459 articles, we included 47 in the review. The identified studies fell into three major categories: (1) studies describing the incidental diagnosis of cancer in the ED (n = 11, 23%), (2) studies characterizing the acute initial presentation of cancer in the ED (n = 19, 41%), and (3) studies describing the ED as a pathway to cancer diagnosis in the healthcare system (n = 17, 36%). Across the studies, cancer diagnoses in the ED were more likely in patients with higher comorbidities, occurred at later stages, and resulted in worse survival rates. Conclusions The ED plays a prominent role in the initial diagnosis of cancer. Efforts must be made to integrate the ED within the cancer care continuum.

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Analysis of Risk Factors, Treatment Patterns, and Survival Outcomes After Emergency Presentation With Colorectal Cancer: A Prospective Multicenter Cohort Study in Nigeria

Aderibigbe,

Dare,

Kalvin

et al. 2024

Journal of Surgical Oncology

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Background and ObjectivesProspective data on presentation and outcomes of colorectal cancer (CRC) in Nigeria are limited; however, emergency presentation with advanced disease is thought common.MethodsConsecutive CRC patients presenting at six sites over 6 years were included. Risk factors for emergency presentation were evaluated using logistic regression methods. Overall survival (OS) was compared between emergent and elective patients using Kaplan‐Meier methods and the log‐rank test.ResultsOf 535 patients, 30.7% presented emergently. Median age was 56 years, 55% were men, and 5.0% reported a cancer family history. Emergency patients had more proximal cancers (42.1% vs. 24.0%), Stage IV disease (61.6% vs. 40.2%; p < 0.001), lower household income (₦35 000/month vs. ₦50 000/month), lower education levels (p = 0.008) and accessed care with nonmotorized transport (50.6% vs. 37.2%; p = 0.005). Median OS was shorter in the emergency group (6.4 vs. 17.4 months; p < 0.001). Across clinical stages, emergency presentation was associated with worse OS (Stage IV median OS 4.8 vs. 9.4 months; p = 0.002). Surgery improved survival in both groups, although emergency patients had higher 30‐day postoperative mortality (23.2% vs. 9.1%; p < 0.001).ConclusionsEmergent Nigerian CRC patients have worse OS than elective patients. Cancer control efforts should focus on faster cancer detection, early presentation, diagnosis, and treatment.

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Diagnosis Setting and Colorectal Cancer Outcomes: The Impact of Cancer Diagnosis in the Emergency Department

Cited by 18 publications

References 22 publications

Impact of COVID-19 on the Mode of Presentation and Stage at Diagnosis of Colorectal Cancer

Impact of COVID-19 on the Mode of Presentation and Stage at Diagnosis of Colorectal Cancer

Diagnosis of cancer in the Emergency Department: A scoping review

Analysis of Risk Factors, Treatment Patterns, and Survival Outcomes After Emergency Presentation With Colorectal Cancer: A Prospective Multicenter Cohort Study in Nigeria

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