D. Weithorn1, G. Umadat1, P. Friedmann1, R. Narang1, R. Huang1, R. Levine1, H. In1 1Albert Einstein College Of Medicine,Surgery,Bronx, NY, USA
Introduction: Patients with colorectal cancer who initially present through the Emergency Department (ED) for colorectal cancer diagnosis have worse outcomes, including poorer stage-adjusted prognosis. Colonoscopy has been associated with improved survival but has not been studied in the context of persons presenting through the ED. We aimed to examine the characteristics of patients who get diagnosed with colorectal cancer through a visit to the ED, including prior colonoscopy and symptoms.
Methods: Patients diagnosed with colorectal cancer in one year (2013) in a single urban academic institution were analyzed. A detailed retrospective chart review was conducted to identify if the first presentation that lead to the cancer diagnosis was through the ED (ED-Dx), and for colonoscopy history prior to cancer diagnosis. Kaplan-Meier Analysis was used to examine survival. Differences between persons presenting to the ED and not were compared using univariate and multivariate analyses.
Results: We identified 226 patients with newly diagnosed colorectal cancer eligible for analysis. 40% of patients had cancer diagnosed through a visit to the ED. Colonoscopy information was available for 72% of patients. About half of these patients had history of colonoscopy prior to their cancer diagnosis. ED-Dx patients were more likely to be either younger than 50 (13% vs 9%) or older than 80 (34% vs 19%) and less likely to be 50-65 years old (16% vs 36%, p=0.005). They presented at an advanced stage (40% vs 15%, P<0.001) and were less likely to have had a prior colonoscopy (20% vs 48%, p<0.001). ED-Dx more commonly presented with symptoms (89% vs. 56%, P<0.001), and “pain” was the most common symptom (47% vs 19%, P<0.001). ED-Dx had significantly poorer 18-month survival (94% vs 81%, p=0.006). On multivariate analysis adjusting for all variables, we found ED-Dx to be less likely to have had a prior colonoscopy (OR 0.24, CI 0.1 to 0.6), more likely to have had symptoms (OR 4.33, CI 1.69 to 11.1) and have stage IV cancer (OR 8.13, CI 2.44 to 27.1). Patients with Medicare were more likely to be ED-Dx compared to those with private insurance (OR 4.68, CI 1.01 to 21.7).
Conclusion: Outcomes of patients with ED-Dx are poor. Identifying the health patterns and clinical attributes of these persons represents an opportunity to develop programs to improve the outcomes of cancer patients. Decreased utilization of colonoscopy during routine health care for patients diagnosed through the ED suggest that these patients may be underutilizing health care services, including cancer screening. Based on our observations, a key modifiable factor may be the increased utilization of colorectal screening.
