Contrasting effects of comorbidities on emergency colon cancer diagnosis: a longitudinal data-linkage study in England

BMC Health Services Research

Camille Maringe¹  Bernard Rachet¹  Willie Hamilton²  Georgios Lyratzopoulos³  Cristina Renzi⁴ 

[1] 0000 0004 0425 469X, grid.8991.9, Department of Non-communicable Disease Epidemiology, Cancer Survival Group, London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, WC1E 7HT, London, UK;0000 0004 1936 8024, grid.8391.3, University of Exeter Medical School, St Luke’s Campus, Heavitree Road, EX1 2LU, Exeter, UK;0000000121901201, grid.83440.3b, Department of Behavioural Science and Health, ECHO (Epidemiology of Cancer Healthcare & Outcomes) Research Group, University College London, 1-19 Torrington Place, WC1E 6BT, London, UK;0000000121901201, grid.83440.3b, Department of Behavioural Science and Health, ECHO (Epidemiology of Cancer Healthcare & Outcomes) Research Group, University College London, 1-19 Torrington Place, WC1E 6BT, London, UK;0000 0004 0425 469X, grid.8991.9, Department of Non-communicable Disease Epidemiology, Cancer Survival Group, London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, WC1E 7HT, London, UK;

关键词: Colon cancer;    Comorbidity;    Chronic conditions;    Emergency presentations;    Diagnosis;    Symptoms;   

DOI  :  10.1186/s12913-019-4075-4

来源: publisher

【 摘 要 】

BackgroundOne in three colon cancers are diagnosed as an emergency, which is associated with worse cancer outcomes. Chronic conditions (comorbidities) affect large proportions of adults and they might influence the risk of emergency presentations (EP).MethodsWe aimed to evaluate the effect of specific pre-existing comorbidities on the risk of colon cancer being diagnosed following an EP rather than through non-emergency routes. The cohort study included 5745 colon cancer patients diagnosed in England 2005–2010, with individually-linked cancer registry, primary and secondary care data. In addition to multivariable analyses we also used potential-outcomes methods.ResultsColon cancer patients with comorbidities consulted their GP more frequently with cancer symptoms during the pre-diagnostic year, compared with non-comorbid cancer patients. EP occurred more frequently in patients with ‘serious’ or complex comorbidities (diabetes, cardiac and respiratory diseases) diagnosed/treated in hospital during the years pre-cancer diagnosis (43% EP in comorbid versus 27% in non-comorbid individuals; multivariable analysis Odds Ratio (OR), controlling for socio-demographic factors and symptoms: men OR = 2.40; 95% CI 2.0–2.9 and women OR = 1.98; 95% CI 1.6–2.4. Among women younger than 60, gynaecological (OR = 3.41; 95% CI 1.2–9.9) or recent onset gastro-intestinal conditions (OR = 2.84; 95% CI 1.1–7.7) increased the risk of EP. In contrast, primary care visits for hypertension monitoring decreased EPs for both genders.ConclusionsPatients with comorbidities have a greater risk of being diagnosed with cancer as an emergency, although they consult more frequently with cancer symptoms during the year pre-cancer diagnosis. This suggests that comorbidities may interfere with diagnostic reasoning or investigations due to ‘competing demands’ or because they provide ‘alternative explanations’. In contrast, the management of chronic risk factors such as hypertension may offer opportunities for earlier diagnosis. Interventions are needed to support the diagnostic process in comorbid patients. Appropriate guidelines and diagnostic services to support the evaluation of new or changing symptoms in comorbid patients may be useful.

【 授权许可】

CC BY