Emergency admission for cancer: a matter of survival?

Abstract

Summary The objective of this study was to compare the pre-hospital health care process, clinical characteristics at admission and survival of patients with a digestive tract cancer first admitted to hospital either electively or via the emergency department. The study involved crosssectional analysis of information elicited through personal interview and prospective follow-up. The setting was a 450-bed public teaching hospital primarily serving a low-income area of Barcelona, Catalonia, Spain. Two hundred and forty-eight symptomatic patients were studied, who had cancer of the oesophagus (n = 31), stomach (n = 70), colon (n = 82) and rectum (n = 65). The main outcome measures were stage, type and intention of treatment and time elapsed from admission to surgery; the relative risk of death was calculated using Cox's regression. There were 161 (65%) patients admitted via the emergency department and 87 (35%) electively. The type of physician seen at the first prehospital visit had more often been a general practitioner in the emergency than in the elective group (89% vs 75%, P < 0.01). Emergency patients had seen a lower number of physicians from symptom onset until admission, but two-thirds had made repeated visits to a primary care physician. Emergency patients were less likely to have a localized tumour and a diagnosis of cancer at admission, and surgery as the initial treatment. Median survival was 30 months for elective patients and 8 months for emergency patients (P < 0.001), and the relative risk of death (RR) was 1.83 (95% confidence interval, Cl, 1.32-2.54). After adjustment for strong prognostic factors, emergency patients continued to experience a significant excess risk (RR = 1.58; Cl 1.10-2.27). In conclusion, in digestive tract cancers, admission to hospital via the emergency department is a clinically important marker of a poorer prognosis. Emergency departments can only partly counterbalance deficiencies in the effectiveness of and integration among the different levels of the health system.

Colon cancer surgery following emergency presentation: effects on admission and stage-adjusted outcomes

“…A second issue that makes the findings of previous work hard to interpret specifically for colon cancer is the lack of differentiation that all but 2 14,15 of the discussed articles make between colon and rectal disease -an issue shared with many publications on the matter. [19][20][21] Malignancies of the colon and rectum have been shown to be quite different in tumor biology 22 and subsequent prognosis 23 and arguments to split both are a recurring issue in outcome studies.…”

“…Some papers have produced valid points that echo the intuitive assumptions many clinicians have on the topic, but many of the papers laying the foundation for this work are outdated as they are from the prescreening era: a 1995 study by Scott et al 13 gave some of the first evidence pointing at more advanced dis-ease and worse perioperative outcomes for emergency colorectal cancer patients, underlining the importance of screening initiatives, and a 1998 study by Porta et al 14 demonstrated shorter survival rates for patients admitted through the ED in a small set of 80 colon cancer patients. Finally, with data from the same decade, Biondo et al 15 confirmed differences in recurrence and survival in a prospective cohort (1996 to 1998), although not in all stages of disease.…”

Attributes of cancer patients admitted to the emergency department in one year

“…[18][19][20] The results of our study were similar to those of previous studies. Studies [8,11,21,22] found that admission to the ED may be an important indicator for poorer survival. In our study, the mortality rate of cancer patients admitted to the ED was 46.8%.…”

Colorectal cancer survival: Results from a hospital-based cancer registry

“…In Catalonia (3), the 5-year relative survival rate was 42.7% (95%CI 38-48) in 1985-1989 and 52.9% (95% IC 49-57) in 1995-1999. Several publications have observed an independent prognostic effect of factors such as age at diagnosis (4), sex (4,5), stage at diagnosis (6), histological grade (4), anatomical location (4,5), type of treatment received (7), degree of co-morbidity (8), and type of hospital admission (9).…”

“…The Cancer Registry of Hospital del Mar (Barcelona) is one of the best established hospital-based cancer registries in Spain, with comprehensive clinical data and extensive follow-up (9). The aim of this study was to calculate the 5-and 10-year survival rates for patients with newly diagnosed CRC and to assess the prognostic value of clinical factors.…”