Emergency presentation of colorectal cancer linked to higher mortality risk
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GENEVA — A large percentage of people with colorectal cancer around the world are diagnosed through emergency presentation, according to study results presented at World Cancer Congress.
Several factors — including age, cancer type and stage at diagnosis — consistently are linked with increased risk for emergency presentation, and this manner of diagnosis strongly predicts risk for death within 12 months, results showed.
“This provides another realization of the importance of optimizing uptake of colorectal screening, because it can prevent or at least reduce risk for diagnosis through emergency presentation,” Georgios Lyratzopoulos, MD, FFPH, FRCP, MPH, DTM&H, professor of cancer epidemiology at University College London, told Healio. “When emergency presentations do happen, they confer significant excess risk for mortality. For those two reasons, this is a call for redoubling our efforts to optimize colorectal cancer screening participation.”
Single-center studies have shown diagnosis of cancer through emergency presentation is common around the world. It predicts mortality independent of stage, and it is more common among older individuals.
However, it remained unclear whether emergency presentation could be measured internationally, whether predictors and outcomes would be consistent across regions, and if emergency presentation could explain international variations in cancer survival, Lyratzopoulos said.
The International Cancer Benchmarking Partnership — an international, multidisciplinary collaboration intended to improve outcomes for people with cancer — conducted a study to identify predictive factors and the effect of cancer diagnosis through emergency presentation in different regions around the world.
Lyratzopoulos and colleagues also sought to identify potential associations with jurisdiction-level cancer survival.
Researchers used a federated analysis model to evaluate cancer registration and linked hospital admissions data from 14 jurisdictions in six countries: Australia, Canada, Denmark, New Zealand, Norway and the United Kingdom.
Patients included in the analysis had been diagnosed with one of eight cancer types — colon, esophageal, liver, lung, ovarian, pancreatic, rectal or stomach — between 2012 and 2017.
Investigators defined emergency presentation as cancer diagnosis within 30 days after an emergency hospital admission. They examined associations between specific variables and emergency presentation, as well as associations between emergency presentation and mortality.
They performed meta-analyses of estimates across jurisdictions, and they evaluated jurisdiction-level data related to cancer survival and percentage of patients diagnosed through emergency presentation.
The analysis included 857,068 people with one of the eight evaluated malignancies.
Nearly one in three (29%; n = 65,547 of 222,629) colon cancer cases were diagnosed after emergency presentation. Researchers reported “very highly consistent” findings across the 14 jurisdictions evaluated, with findings revealing older age and later disease stage to be associated with diagnosis through emergency presentation. Lyratzopoulos reported “very little variability” by sex.
“This is good news in terms of methodology,” Lyratzopoulos said. “It shows the data quality is highly consistent, and our definition also has high consistency. From a personal point of view, it is very reassuring to see this.”
Slightly more than one in 10 (12%; n = 10,051 of 83,325) rectal cancer cases were diagnosed after emergency presentation. Researchers again reported consistent variation by age and disease stage.
Patients diagnosed with colon cancer through emergency presentation exhibited significantly higher risk for 12-month mortality, with ORs in each jurisdiction ranging from 3.05 to 4.75.
“People diagnosed through emergency presentation are more likely to have advanced-stage disease, but stage is not the whole picture,” Lyratzopoulos said. “Once we adjusted for stage at diagnosis, about a third of the association goes away and we are left with [ORs] on the order of 2.5 or greater.”
Jurisdiction-level analyses showed a 10% increase in emergency presentation of colon cancer equated to a 7% (95% CI, –13 to –1.2) decrease in 1 year survival. However, for rectal cancer, researchers observed no significant association between jurisdiction-level emergency presentation percentage and 1-year survival.
Lyratzopoulos characterized emergency presentation-related mortality as a “holistic cancer control and surveillance problem.”
Strategies must include prevention — by addressing obesity, dietary factors and physical inactivity — and expanding age-stratified and targeted screening for high-risk groups. Early diagnosis of symptomatic disease also is necessary through increased public awareness, support for evidenced-based referrals, and optimization of diagnostic pathways and diagnostic services capacity, Lyratzopoulos said.
Although the United States was not included in this study, the results “absolutely” are replicable, Lyratzopoulos said.
“From the evidence we have, we know this is a global phenomenon for cancer — particularly for colon cancer and lung cancer,” he told Healio.
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Lyratzopoulos G, et al. Abstract 1412. Presented at: World Cancer Congress; Oct. 18-20, 2022; Geneva.
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