20-05-2025
Comorbidities Tied to Emergency CRC Diagnoses
A substantial proportion of colorectal cancer (CRC) cases were diagnosed through emergency presentations, with increased odds observed among patients younger than 50 years or aged 80 years or older, those with a lower socioeconomic status, individuals who were widowed, and those with three or more comorbidities.
METHODOLOGY:
Emergency diagnoses of cancer are associated with poorer survival rates. Given that socioeconomic status and comorbidities can influence diagnostic pathways, evaluating these factors is vital for improving care.
Researchers conducted a retrospective cohort study using data from an Italian cancer registry linked to administrative health databases to examine how comorbidities and socioeconomic status affect CRC diagnostic routes; cases were diagnosed between July 2014 and December 2020.
Three mutually exclusive diagnostic routes were examined: Screening, emergency presentation, and inpatient or outpatient visits. Researchers also assessed cancer stage at diagnosis and short-term mortality.
TAKEAWAY:
Researchers included 14,457 patients diagnosed with CRC (74.4% with colon cancer and 25.6% with rectal cancer).
D iagnostic routes were reconstructed for 97.8% of patients with colon cancer (median age, 73.1 years; 47.1% women) and 98.1% of those with rectal cancer (median age, 70.3 years; 42.8% women).
Among colon cancer cases, 35.6% were diagnosed via emergency presentation, 8.4% via screening, and 22.6% during inpatient/outpatient visits. For rectal cancer, the corresponding rates were 22.6%, 9.5%, and 67.8%, respectively.
Emergency diagnosis of colon cancer was more likely among patients younger than 50 years or aged 80 years or older, those in the highest deprivation socioeconomic index quintile, single or widowed individuals (vs married), and those with three or more comorbidities (vs none).
Conversely, patients with three or more comorbidities were less likely to be diagnosed with colon cancer through screening than during inpatient/outpatient visits.
For both colon and rectal cancers, diagnosis through emergency presentations was associated with significantly higher 30-day and 1-year mortalities than diagnosis through inpatient/outpatient visits ( P < .001 for all).
IN PRACTICE:
'Tailored interventions are needed to facilitate screening, to reduce emergency cancer diagnoses, and to improve outcomes for a large number of patients with chronic conditions,' the authors wrote.
SOURCE:
This study was led by Flavia Pennisi, MD, School of Medicine, University Vita-Salute San Raffaele, Milan, Italy. It was published online in JAMA Network Open .
LIMITATIONS:
The lack of individual-level electronic health records limited access to symptom data at diagnosis, hindering the ability to differentiate between symptomatic and asymptomatic cases. This study focused on observed associations rather than causal relationships.
DISCLOSURES:
This study was funded by a grant and an award from Early Detection and Diagnosis Committee from Cancer Research UK. The authors reported having no conflicts of interest.
