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Older patients, women face greater risk for emergency cancer diagnosis
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Older individuals were at an increased risk for the diagnosis of lung and colorectal cancers during emergency presentation, according to results of a literature review.
Sex, marital status and socioeconomic factors also contributed to a higher risk for emergency cancer presentation, results showed.
“It may be that some patients don’t go to the general practitioner about early cancer symptoms — especially if they live alone — or they become ill very quickly, leading to an emergency diagnosis in hospital,” Elizabeth D. Mitchell, MD, of the Centre for Health Services Research at the Leeds Institute of Health Sciences, United Kingdom, said in a press release. “Knowing more about these influences could help us to find ways of ensuring that more cancers are spotted earlier, when patients often have a better chance of survival.”
Emergency presentation is one of the most frequent forms of cancer diagnosis, according to study background. However, the factors influencing emergency diagnoses remained unclear, researchers wrote.
Mitchell and colleagues performed a systematic review of 22 studies to evaluate factors associated with emergency diagnoses of lung and colorectal cancers. Eleven of the studies were conducted in the U.K. Researchers excluded studies that included patients with previous cancer diagnoses, as well as studies that focused on outcomes related to diagnosis and treatment.
Overall, the studies provided data on more than 200,000 emergency presentations of cancer (median per study, 178).
Seventeen of the studies evaluated patient-related risk factors for emergency presentation.
Researchers observed a statistically significant relationship between older age and emergency presentation of lung cancer (range, OR = 1.11-11.03) and colorectal cancer (range, OR = 1.19-5.85). The definition of older patient age (60 to ≥ 90 years) varied across studies; however, older populations consistently displayed an increased risk for emergency diagnoses regardless of age classification.
Women were at greater risk for an emergency diagnosis of lung cancer; however, there was not a significant association between female gender and emergency colorectal cancer diagnosis.
The highest level of socioeconomic deprivation was associated with a 4% to 21% increased likelihood of receiving an emergency diagnosis of lung cancer, and researchers also observed a connection between lower income and emergency colorectal cancer diagnosis.
Emergency presentations of colorectal cancer were more likely among individuals with Medicare (OR = 2.66; 95% CI, 1.89-3.72) or who were self-paying (OR = 2.08; 95% CI, 1.3-3.33).
Individuals who were unmarried, divorced or widowed were more likely to receive emergency diagnoses of lung and colorectal cancers. One study yielded a link between emergency diagnosis and childlessness (P = .021); however, this association did not reach statistical significance in a multivariate analysis.
Researchers did not determine a link between emergency presentation and education level, geographic location or social class.
The researchers acknowledged limitations of their study, including the low number of evaluative studies and the lack of randomized control trials.
“Patient-related factors, such as age, gender and socioeconomic deprivation, have an influence on diagnosis of cancer during an emergency presentation,” Mitchell and colleagues concluded. “While it may be the case that such patients become sick very quickly and need to be admitted to hospital, further work is needed to understand the context in which risk factors of emergency presentation exist and influence help-seeking behavior. Until then, we may be unable to develop suitable interventions to ensure that patients are detected earlier in their pathway to diagnosis.” – by Cameron Kelsall
Disclosure: The researchers report no relevant financial disclosures.
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