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Burton A, Wilburn J, Driver RJ, Wallace D, McPhail S, Cross TJS, Rowe IA, Marshall A. Routes to diagnosis for hepatocellular carcinoma patients: predictors and associations with treatment and mortality. Br J Cancer 2024; 130:1697-1708. [PMID: 38499728 DOI: 10.1038/s41416-024-02645-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 02/22/2024] [Accepted: 02/26/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) incidence has increased rapidly, and prognosis remains poor. We aimed to explore predictors of routes to diagnosis (RtD), and outcomes, in HCC cases. METHODS HCC cases diagnosed 2006-2017 were identified from the National Cancer Registration Dataset and linked to Hospital Episode Statistics and the RtD metric. Multivariable logistic regression was used to explore associations between RtD, diagnosis year, 365-day mortality and receipt of potentially curative treatment. RESULTS 23,555 HCC cases were identified; 36.1% via emergency presentation (EP), 30.2% GP referral (GP), 17.1% outpatient referral, 11.0% two-week wait and 4.6% other/unknown routes. Odds of 365-day mortality was >70% lower via GP or OP routes than EP, and odds of curative treatment 3-4 times higher. Further adjustment for cancer/cirrhosis stage attenuated the associations with curative treatment. People who were older, female, had alcohol-related liver disease, or were more deprived, were at increased risk of an EP. Over time, diagnoses via EP decreased, and via GP increased. CONCLUSIONS HCC RtD is an important predictor of outcomes. Continuing to reduce EP and increase GP and OP presentations, for example by identifying and regularly monitoring patients at higher risk of HCC, may improve stage at diagnosis and survival.
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Affiliation(s)
- Anya Burton
- National Disease Registration Service, NHS England, Quarry House, Quarry Hill, Leeds, LS2 7UE, UK.
- Bristol Medical School, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
| | - Jennifer Wilburn
- National Disease Registration Service, NHS England, Quarry House, Quarry Hill, Leeds, LS2 7UE, UK
| | - Robert J Driver
- Leeds Institute for Medical Research at St. James's, University of Leeds, Leeds, LS9 7TF, UK
| | - David Wallace
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
- Institute of Liver Studies, Kings College Hospital, Denmark Hill, London, SE5 9RS, UK
| | - Sean McPhail
- National Disease Registration Service, NHS England, Quarry House, Quarry Hill, Leeds, LS2 7UE, UK
| | - Tim J S Cross
- Liverpool Experimental Cancer Medicine Centre, University of Liverpool, Liverpool, L7 8XP, UK
| | - Ian A Rowe
- Leeds Institute for Medical Research at St. James's, University of Leeds, Leeds, LS9 7TF, UK
| | - Aileen Marshall
- Sheila Sherlock Liver Centre, The Royal Free Hospital, London, NW3 2QG, UK
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2
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Khalaf N, Ali B, Liu Y, Kramer JR, El-Serag H, Kanwal F, Singh H. Emergency Presentations Predict Worse Outcomes Among Patients with Pancreatic Cancer. Dig Dis Sci 2024; 69:603-614. [PMID: 38103105 DOI: 10.1007/s10620-023-08207-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 11/22/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Emergency presentation (EP) of cancer, a new cancer diagnosis made following an emergency department (ED) visit, is associated with worse patient outcomes and greater organizational stress on healthcare systems. Pancreatic cancer has the highest rate of EPs among European studies but remains understudied in the U.S. AIMS To evaluate the association between pancreatic cancer EPs and cancer stage, treatment, and survival. METHODS We conducted a retrospective cohort study among patients with pancreatic adenocarcinoma diagnosed from 2007 to 2019 at a tertiary-care Veterans Affairs medical center. Electronic health records were reviewed to identify EP cases, defined as a new pancreatic cancer diagnosis made within 30 days of an ED visit where cancer was suspected. We used multivariate logistic regression models and Cox proportional hazards models to examine the associations between EPs and cancer stage, treatment, and survival. RESULTS Of 243 pancreatic cancer patients, 66.7% had EPs. There was no difference in stage by EP status. However, patients diagnosed through EPs were 72% less likely to receive cancer treatment compared to non-emergency presenters (adjusted OR 0.28; 95% CI 0.13-0.57). Patients with EPs also had a 73% higher mortality risk (adjusted HR 1.73; 95% CI 1.29-2.34). This difference in mortality remained statistically significant after adjusting for cancer stage and receipt of cancer treatment (adjusted HR 1.47; 95% CI 1.09-1.99). CONCLUSIONS Pancreatic cancer EPs are common and independently associated with lower treatment rates and survival. Enhanced understanding of process breakdowns that lead to EPs can help identify care gaps and inform future quality improvement efforts.
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Affiliation(s)
- Natalia Khalaf
- Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Blvd. MS:111-D, Houston, TX, 77030, USA.
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
| | - Basim Ali
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Yan Liu
- Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Blvd. MS:111-D, Houston, TX, 77030, USA
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Jennifer R Kramer
- Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Blvd. MS:111-D, Houston, TX, 77030, USA
- Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Hashem El-Serag
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Fasiha Kanwal
- Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Blvd. MS:111-D, Houston, TX, 77030, USA
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Hardeep Singh
- Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Blvd. MS:111-D, Houston, TX, 77030, USA
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
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Hargreaves S, Clayton K, Creech L, Darlison L, Ejegi-Memeh S, Fenemore J, Gardiner C, Taylor B, Tod A. Impact of Covid-19 on lung cancer and Mesothelioma specialist nurses: A survey of experiences and perceptions. Eur J Oncol Nurs 2022; 61:102207. [PMID: 36240682 PMCID: PMC9526868 DOI: 10.1016/j.ejon.2022.102207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 08/22/2022] [Accepted: 09/23/2022] [Indexed: 11/30/2022]
Abstract
Purpose The covid-19 global pandemic has impacted on nurses who have rapidly adapted to new ways of working, and experienced negative impacts due to over-stretched services. Two surveys captured the experiences of lung cancer and mesothelioma specialist nurses in the United Kingdom (UK) in 2020, but the impact of later stages of the pandemic was unknown. This study aimed to explore the impact of covid-19 on lung Cancer and mesothelioma nurses since January 2021, the second wave of the pandemic. Methods An online cross-sectional survey with both open and closed questions explored the impact of covid-19 on ways of working and workload, quality of care, and health and wellbeing. The survey was open to UK based lung cancer and mesothelioma advanced or specialist nurses. Results 85 nurses responded to the survey. The majority were Clinical Nurse Specialists, based in England. Respondents reported changes in ways of working due to redeployment, staff shortages, and home working. Widespread adoption of virtual working practices led to concerns of negative impacts. Perceived excessive workload impacted on care with two-thirds of the sample (57, 67%) reporting they had been unable to provide the same quality of care to patients. Impacts on nurses’ health and wellbeing were reported with two-thirds of the sample (56, 66%) reporting a deterioration in emotional wellbeing and mental health. Coping mechanisms employed included online team support to share experiences and increased uptake of exercise; however, impacts on lifestyle and access to coping mechanisms varied. Conclusion Nurses have stepped up to the challenges of the pandemic with teamwork and innovation, but pressure arising from the pandemic and high workloads led to negative impacts on wellbeing. The authors have provided recommendations to improve patient care and support the wellbeing of nurses, which will be key to a resilient workforce living with covid-19. Whilst this study focussed on lung cancer and mesothelioma specialists, the findings have wider implications for other cancer specialties.
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Schiavetti A, Aliotti Lippolis M, Gentile I, De Grazia A, Ferrara E, Bonci E. First-Time Diagnosis After an Emergency Presentation in Children With Cancer. Pediatr Emerg Care 2022; 38:e650-e653. [PMID: 33645937 DOI: 10.1097/pec.0000000000002329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM To determine the prevalence rate of cancer diagnoses by an emergency route, the related risk factors and whether the emergency diagnosis was associated with poorer outcome. METHODS Retrospective observational study with identification of patients diagnosed at the Pediatric Oncology Unit of "Sapienza" University between 2008 and 2018. The percentage of patients who received a first-time diagnosis after an emergency presentation was determined. Two-year survival and clinical factors, such as sex, age and histology, associated to emergency presentation were evaluated. RESULTS Of 207 patients (109 girls and 98 boys; median age, 120 months), with a first-time diagnosis of solid tumor, 5.8% were diagnosed during an emergency admission after a median latency time of 2.5 days. Cases with an emergency diagnosis were younger compared with those who were diagnosed electively (median age, 30 months vs 120 months, P < 0.005). Higher prevalence rate of emergency presentation was detected in patients with lymphoma compared with those with no lymphoma disease (28.6% vs 4.1%; P < 0.0001). All patients were managed to overcome their emergency presentation, 33.3% of these died later. No statistically significant difference for 2-year overall survival was found between patients with an emergency diagnosis and those with elective diagnosis (66.7% vs 81.0%; odds ratio, 2.1; confidence interval, 0.6-7.5; P = 0.22). CONCLUSIONS A minor but not negligible number of pediatric patients come to a first-time diagnosis of cancer as result of a life-threatening event; risk factors were younger age and lymphoma disease. The emergency event can be successfully treated, and it was not related to a poorer survival.
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Affiliation(s)
| | | | | | | | | | - Enea Bonci
- Department of Experimental Medicine, Sapienza University, Rome, Italy
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Popat S, Navani N, Kerr KM, Smit EF, Batchelor TJ, Van Schil P, Senan S, McDonald F. Navigating Diagnostic and Treatment Decisions in Non-Small Cell Lung Cancer: Expert Commentary on the Multidisciplinary Team Approach. Oncologist 2021; 26:e306-e315. [PMID: 33145902 PMCID: PMC7873339 DOI: 10.1002/onco.13586] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 10/20/2020] [Indexed: 12/11/2022] Open
Abstract
Non-small cell lung cancer (NSCLC) accounts for approximately one in five cancer-related deaths, and management requires increasingly complex decision making by health care professionals. Many centers have therefore adopted a multidisciplinary approach to patient care, using the expertise of various specialists to provide the best evidence-based, personalized treatment. However, increasingly complex disease staging, as well as expanded biomarker testing and multimodality management algorithms with novel therapeutics, have driven the need for multifaceted, collaborative decision making to optimally guide the overall treatment process. To keep up with the rapidly evolving treatment landscape, national-level guidelines have been introduced to standardize patient pathways and ensure prompt diagnosis and treatment. Such strategies depend on efficient and effective communication between relevant multidisciplinary team members and have both improved adherence to treatment guidelines and extended patient survival. This article highlights the value of a multidisciplinary approach to diagnosis and staging, treatment decision making, and adverse event management in NSCLC. IMPLICATIONS FOR PRACTICE: This review highlights the value of a multidisciplinary approach to the diagnosis and staging of non-small cell lung cancer (NSCLC) and makes practical suggestions as to how multidisciplinary teams (MDTs) can be best deployed at individual stages of the disease to improve patient outcomes and effectively manage common adverse events. The authors discuss how a collaborative approach, appropriately leveraging the diverse expertise of NSCLC MDT members (including specialist radiation and medical oncologists, chest physicians, pathologists, pulmonologists, surgeons, and nursing staff) can continue to ensure optimal per-patient decision making as treatment options become ever more specialized in the era of biomarker-driven therapeutic strategies.
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Affiliation(s)
- Sanjay Popat
- Lung Unit, Royal Marsden HospitalLondonUnited Kingdom
- The Institute of Cancer Research, University of LondonLondonUnited Kingdom
| | - Neal Navani
- Lungs for Living Research Centre, University College London (UCL) Respiratory, UCL and Department of Thoracic Medicine, University College London Hospitals NHS Foundation TrustLondonUnited Kingdom
| | - Keith M. Kerr
- Department of Pathology, Aberdeen University Medical School and Aberdeen Royal InfirmaryAberdeenUnited Kingdom
| | - Egbert F. Smit
- Department of Pulmonary Diseases, VU University Medical Center and Department of Thoracic Oncology, The Netherlands Cancer InstituteAmsterdamThe Netherlands
| | - Timothy J.P. Batchelor
- Department of Thoracic Surgery, University Hospitals Bristol and Weston National Health Service Foundation TrustBristolUnited Kingdom
| | - Paul Van Schil
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital and Antwerp UniversityAntwerpBelgium
| | - Suresh Senan
- Department of Radiation Oncology, Amsterdam University Medical Center, Free University Amsterdam, Cancer Center AmsterdamAmsterdamThe Netherlands
| | - Fiona McDonald
- Lung Unit, Royal Marsden HospitalLondonUnited Kingdom
- The Institute of Cancer Research, University of LondonLondonUnited Kingdom
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Suhail A, Crocker CE, Das B, Payne JI, Manos D. Initial presentation of lung cancer in the emergency department: a descriptive analysis. CMAJ Open 2019; 7:E117-E123. [PMID: 30808631 PMCID: PMC6404960 DOI: 10.9778/cmajo.20180061] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Guidelines aimed at improving care for lung cancer, the leading cause of cancer-related death in Canada and worldwide, require accurate knowledge of the diagnostic setting or pathway. We sought to determine how often lung cancer is initially diagnosed through the emergency department. METHODS We performed a descriptive study that included all cases of primary lung cancer diagnosed in residents of Nova Scotia in 2014. Cancer registry data included diagnostic data and date of death to Aug. 31, 2016. We reviewed linked hospital records, including laboratory and imaging results, to identify the first positive diagnostic study and the route of presentation (emergency department v. other). We evaluated time from diagnosis to death as a function of presentation route using Kaplan-Meier curves and Cox regression (hazard rate ratios [HRRs]). RESULTS Sufficient data were available for 946 of 951 cases identified, of which 336 (35.5%) were diagnosed through the emergency department. Cases diagnosed via the emergency department were more likely to be at an advanced stage (stage IV, 59.5% v. 43.4%), with patients experiencing shorter survival (1-yr survival, 28.4% v. 49.5%), including stage-specific survival. Mortality for cases diagnosed in the emergency department was 54% higher than for the non-emergency department group after adjusting for age and stage (HRR 1.54, 95% confidence interval 1.32-1.81). Few patients (7.1%, n = 24) who presented to the emergency department reported having no family physician. INTERPRETATION The emergency department is a common route of presentation for lung cancer and is associated with advanced stage at diagnosis and reduced survival time. Strategies are needed to encourage pre-emergent diagnosis and to ensure that emergency providers are supported in the initial care of patients with lung cancer.
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Affiliation(s)
- Aamir Suhail
- Departments of Diagnostic Radiology (Suhail, Crocker, Payne, Manos), Psychiatry (Crocker) and Emergency Medicine (Das), Dalhousie University, Halifax, NS
| | - Candice E Crocker
- Departments of Diagnostic Radiology (Suhail, Crocker, Payne, Manos), Psychiatry (Crocker) and Emergency Medicine (Das), Dalhousie University, Halifax, NS
| | - Bijon Das
- Departments of Diagnostic Radiology (Suhail, Crocker, Payne, Manos), Psychiatry (Crocker) and Emergency Medicine (Das), Dalhousie University, Halifax, NS
| | - Jennifer I Payne
- Departments of Diagnostic Radiology (Suhail, Crocker, Payne, Manos), Psychiatry (Crocker) and Emergency Medicine (Das), Dalhousie University, Halifax, NS
| | - Daria Manos
- Departments of Diagnostic Radiology (Suhail, Crocker, Payne, Manos), Psychiatry (Crocker) and Emergency Medicine (Das), Dalhousie University, Halifax, NS
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Andreano A, Peake MD, Janes SM, Valsecchi MG, Pritchard-Jones K, Hoag JR, Gross CP. The Care and Outcomes of Older Persons with Lung Cancer in England and the United States, 2008–2012. J Thorac Oncol 2018; 13:904-914. [DOI: 10.1016/j.jtho.2018.04.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 04/11/2018] [Accepted: 04/13/2018] [Indexed: 11/16/2022]
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Luque-Fernandez MA, Belot A, Valeri L, Cerulli G, Maringe C, Rachet B. Data-Adaptive Estimation for Double-Robust Methods in Population-Based Cancer Epidemiology: Risk Differences for Lung Cancer Mortality by Emergency Presentation. Am J Epidemiol 2018; 187:871-878. [PMID: 29020131 PMCID: PMC5888939 DOI: 10.1093/aje/kwx317] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 09/01/2017] [Accepted: 09/05/2017] [Indexed: 01/03/2023] Open
Abstract
In this paper, we propose a structural framework for population-based cancer epidemiology and evaluate the performance of double-robust estimators for a binary exposure in cancer mortality. We conduct numerical analyses to study the bias and efficiency of these estimators. Furthermore, we compare 2 different model selection strategies based on 1) Akaike's Information Criterion and the Bayesian Information Criterion and 2) machine learning algorithms, and we illustrate double-robust estimators' performance in a real-world setting. In simulations with correctly specified models and near-positivity violations, all but the naive estimators had relatively good performance. However, the augmented inverse-probability-of-treatment weighting estimator showed the largest relative bias. Under dual model misspecification and near-positivity violations, all double-robust estimators were biased. Nevertheless, the targeted maximum likelihood estimator showed the best bias-variance trade-off, more precise estimates, and appropriate 95% confidence interval coverage, supporting the use of the data-adaptive model selection strategies based on machine learning algorithms. We applied these methods to estimate adjusted 1-year mortality risk differences in 183,426 lung cancer patients diagnosed after admittance to an emergency department versus persons with a nonemergency cancer diagnosis in England (2006-2013). The adjusted mortality risk (for patients diagnosed with lung cancer after admittance to an emergency department) was 16% higher in men and 18% higher in women, suggesting the importance of interventions targeting early detection of lung cancer signs and symptoms.
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Affiliation(s)
- Miguel Angel Luque-Fernandez
- Faculty of Epidemiology and Population Health, Department of Non-Communicable Disease Epidemiology, Cancer Survival Group, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Aurélien Belot
- Faculty of Epidemiology and Population Health, Department of Non-Communicable Disease Epidemiology, Cancer Survival Group, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Linda Valeri
- Laboratory for Psychiatric Biostatistics, McLean Hospital, Belmont, Massachusetts
- Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Giovanni Cerulli
- National Research Council of Italy, Research Institute on Sustainable Economic Growth, Rome, Italy
| | - Camille Maringe
- Faculty of Epidemiology and Population Health, Department of Non-Communicable Disease Epidemiology, Cancer Survival Group, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Bernard Rachet
- Faculty of Epidemiology and Population Health, Department of Non-Communicable Disease Epidemiology, Cancer Survival Group, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Aravani A, Downing A, Thomas JD, Lagergren J, Morris EJA, Hull MA. Obesity surgery and risk of colorectal and other obesity-related cancers: An English population-based cohort study. Cancer Epidemiol 2018; 53:99-104. [PMID: 29414638 PMCID: PMC5865073 DOI: 10.1016/j.canep.2018.01.002] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 12/18/2017] [Accepted: 01/02/2018] [Indexed: 12/13/2022]
Abstract
The association between obesity surgery (OS) and cancer risk remains unclear. Colorectal cancer (CRC) risk is increased in obese individuals. No evidence of increased CRC risk after OS in this English population study. Reduced breast cancer risk was apparent after OS. Renal and endometrial cancer risk is elevated in obese patients.
Background The association between obesity surgery (OS) and cancer risk remains unclear. We investigated this association across the English National Health Service. A population-based Swedish study has previously suggested that OS may increase the risk of developing colorectal cancer (CRC). Methods A retrospective observational study of individuals who underwent OS (surgery cohort) or diagnosed with obesity, but had no OS (no-surgery cohort) (1997–2013) were identified using Hospital Episode Statistics. Subsequent diagnosis of CRC, breast, endometrial, kidney and lung cancer, as well as time ‘at risk’, were determined by linkage to National Cancer Registration & Analysis Service and Office of National Statistics data, respectively. Standardised incidence ratios (SIR) in relation to OS were calculated. Results 1 002 607 obese patients were identified, of whom 3.9% (n = 39 747) underwent OS. In the no-surgery obese population, 3 237 developed CRC (SIR 1.12 [95% CI 1.08–1.16]). In those who underwent OS, 43 developed CRC (SIR 1.26 [95% CI 0.92–1.71]). The OS cohort demonstrated decreased breast cancer risk (SIR 0.76 [95% CI 0.62–0.92]), unlike the no surgery cohort (SIR 1.08 [95% CI 1.04–1.11]). Increased risk of endometrial and kidney cancer was observed in surgery and no-surgery cohorts. Conclusions CRC risk is increased in individuals diagnosed as obese. Prior obesity surgery was not associated with an increased CRC risk. However, the OS population was small, with limited follow-up. Risk of breast cancer after OS is reduced compared with the obese no-surgery population, while the risk of endometrial and kidney cancers remained elevated after OS.
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Affiliation(s)
- Ariadni Aravani
- Leeds Institute of Cancer & Pathology, University of Leeds, Worsley Building, Leeds, LS2 9NL, United Kingdom.
| | - Amy Downing
- Leeds Institute of Cancer & Pathology, University of Leeds, Worsley Building, Leeds, LS2 9NL, United Kingdom.
| | - James D Thomas
- Public Health England, Blenheim House, Duncombe St., Leeds, West Yorkshire, LS1 4PL, United Kingdom.
| | - Jesper Lagergren
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, 17176 Stockholm, Sweden; Division of Cancer Studies, King's College London, WC2R 2LS, United Kingdom.
| | - Eva J A Morris
- Leeds Institute of Cancer & Pathology, University of Leeds, Worsley Building, Leeds, LS2 9NL, United Kingdom.
| | - Mark A Hull
- Leeds Institute of Biomedical & Clinical Sciences, University of Leeds, Wellcome Trust Brenner Building, St. James's University Hospital, Leeds LS9 7TF, United Kingdom.
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10
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Solsky I, Rapkin B, Wong K, Friedmann P, Muscarella P, In H. Gastric cancer diagnosis after presentation to the ED: The independent association of presenting location and outcomes. Am J Surg 2017; 216:286-292. [PMID: 29108643 DOI: 10.1016/j.amjsurg.2017.10.030] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Revised: 10/04/2017] [Accepted: 10/10/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND The impact of diagnosis location on gastric cancer (GC) outcomes is poorly defined. METHODS Detailed chart review was conducted to identify presenting location leading to diagnosis and treatment for GC patients at a single institution (2009-2013). Patients treated non-emergently following a diagnosis prompted by an ED visit (EDdx) were compared with those diagnosed at other locations (non-EDdx). RESULTS EDdx patients comprised 52% of 263 GC patients. They were older, had later cancer stages (stage IV: 50% vs. 24%), more comorbidities (≥3: 68% vs. 47%), and presented with non-specific symptoms like bleeding (21% vs. 5%). Both groups were of similar race and insurance status. In a model adjusted for stage, EDdx was associated with increased mortality (aHR 1.9; 95% CI: 1.2-2.9). CONCLUSION Half of GC patients had an ED visit prompting diagnosis, which is independently associated with increased mortality. Efforts should focus on reducing EDdx rates to improve GC outcomes.
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Affiliation(s)
- Ian Solsky
- Montefiore Medical Center/Albert Einstein College of Medicine, Department of Surgery, Bronx, NY, USA
| | - Bruce Rapkin
- Montefiore Medical Center/Albert Einstein College of Medicine, Department of Epidemiology and Population Health, Bronx, NY, USA
| | - Kristen Wong
- Montefiore Medical Center/Albert Einstein College of Medicine, Department of Surgery, Bronx, NY, USA
| | - Patricia Friedmann
- Montefiore Medical Center/Albert Einstein College of Medicine, Department of Surgery, Bronx, NY, USA
| | - Peter Muscarella
- Montefiore Medical Center/Albert Einstein College of Medicine, Department of Surgery, Bronx, NY, USA
| | - Haejin In
- Montefiore Medical Center/Albert Einstein College of Medicine, Department of Surgery, Bronx, NY, USA.
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Newsom-Davis T. The route to diagnosis: emergency presentation of lung cancer. Lung Cancer Manag 2017; 6:67-73. [PMID: 30643572 DOI: 10.2217/lmt-2017-0004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 07/03/2017] [Indexed: 11/21/2022] Open
Abstract
A significant proportion of lung cancer patients are first diagnosed as part of an emergency presentation (EP) to acute medical services. This route to diagnosis is a strong negative predictor of survival, and is associated with age, deprivation and medical co-morbidities. Patients are less likely to receive anticancer treatment than those diagnosed through elective routes. The causes of EP of cancer are complex. When it is unavoidable, prompt input from specialist lung cancer services is needed. Preventing EP of lung cancer involves streamlined diagnostic pathways, public health campaigns about symptoms, decision-support tools for general practitioners, improved communication and access for primary and secondary care, and focus on vague symptoms. Reducing EP of lung cancer is important when improving outcomes and patient experience.
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Affiliation(s)
- Thomas Newsom-Davis
- Department of Oncology, Chelsea & Westminster Hospital NHS Foundation Trust, 369 Fulham Road, London SW10 9NH, UK
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12
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Zhou Y, Abel GA, Hamilton W, Pritchard-Jones K, Gross CP, Walter FM, Renzi C, Johnson S, McPhail S, Elliss-Brookes L, Lyratzopoulos G. Diagnosis of cancer as an emergency: a critical review of current evidence. Nat Rev Clin Oncol 2017; 14:45-56. [PMID: 27725680 DOI: 10.1038/nrclinonc.2016.155] [Citation(s) in RCA: 111] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Many patients with cancer are diagnosed through an emergency presentation, which is associated with inferior clinical and patient-reported outcomes compared with those of patients who are diagnosed electively or through screening. Reducing the proportion of patients with cancer who are diagnosed as emergencies is, therefore, desirable; however, the optimal means of achieving this aim are uncertain owing to the involvement of different tumour, patient and health-care factors, often in combination. Most relevant evidence relates to patients with colorectal or lung cancer in a few economically developed countries, and defines emergency presentations contextually (that is, whether patients presented to emergency health-care services and/or received emergency treatment shortly before their diagnosis) as opposed to clinically (whether patients presented with life-threatening manifestations of their cancer). Consistent inequalities in the risk of emergency presentations by patient characteristics and cancer type have been described, but limited evidence is available on whether, and how, such presentations can be prevented. Evidence on patients' symptoms and health-care use before presentation as an emergency is sparse. In this Review, we describe the extent, causes and implications of a diagnosis of cancer following an emergency presentation, and provide recommendations for public health and health-care interventions, and research efforts aimed at addressing this under-researched aspect of cancer diagnosis.
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Affiliation(s)
- Yin Zhou
- The Primary Care Unit, Department of Public Health and Primary Care, Institute of Public Health, Forvie Site, Robinson Way, University of Cambridge, Cambridge CB2 0SR, UK
| | - Gary A Abel
- The Primary Care Unit, Department of Public Health and Primary Care, Institute of Public Health, Forvie Site, Robinson Way, University of Cambridge, Cambridge CB2 0SR, UK
- University of Exeter, College House, St Luke's Campus, Exeter EX2 4TE, UK
| | - Willie Hamilton
- University of Exeter, College House, St Luke's Campus, Exeter EX2 4TE, UK
| | - Kathy Pritchard-Jones
- Institute of Child Health, University College London, 30 Guilford Street, London WC1N 1EH, UK
- University College London Partners Academic Health Science Network, 170 Tottenham Court Road, London W1T 7HA, UK
| | - Cary P Gross
- Section of General Medicine, Cancer Outcomes Public Policy and Effectiveness Research (COPPER) Center, Yale University School of Medicine, New Haven, Connecticut 06519, USA
| | - Fiona M Walter
- The Primary Care Unit, Department of Public Health and Primary Care, Institute of Public Health, Forvie Site, Robinson Way, University of Cambridge, Cambridge CB2 0SR, UK
| | - Cristina Renzi
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London WC1E 7HB, UK
| | - Sam Johnson
- National Cancer Registration and Analysis Service, Public Health England Zone A, 2nd Floor, Skipton House, 80 London Road, London SE1 6LH, UK
| | - Sean McPhail
- National Cancer Registration and Analysis Service, Public Health England Zone A, 2nd Floor, Skipton House, 80 London Road, London SE1 6LH, UK
| | - Lucy Elliss-Brookes
- National Cancer Registration and Analysis Service, Public Health England Zone A, 2nd Floor, Skipton House, 80 London Road, London SE1 6LH, UK
| | - Georgios Lyratzopoulos
- The Primary Care Unit, Department of Public Health and Primary Care, Institute of Public Health, Forvie Site, Robinson Way, University of Cambridge, Cambridge CB2 0SR, UK
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London WC1E 7HB, UK
- National Cancer Registration and Analysis Service, Public Health England Zone A, 2nd Floor, Skipton House, 80 London Road, London SE1 6LH, UK
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Solsky I, Friedmann P, Muscarella P, In H. Poor Outcomes of Gastric Cancer Surgery After Admission Through the Emergency Department. Ann Surg Oncol 2016; 24:1180-1187. [PMID: 27909825 DOI: 10.1245/s10434-016-5696-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Outcomes after nonelective surgery for gastric cancer (GC) are poorly defined. Our objective was to compare outcomes of patients undergoing nonelective GC surgery after admission through the emergency department (EDSx) with patients receiving elective surgery or surgery after planned admission (non-EDSx) nationally. METHODS The Nationwide Inpatient Sample (NIS) database was used to examine patients undergoing GC surgery between 2008 and 2012. Demographics and outcomes were compared between EDSx and non-EDSx. Multivariable logistic regression was used to examine predictors of discharge to home. RESULTS Of 9279 patients, 1143 (12%) underwent EDSx. They were more likely to be female (42 vs. 35%), nonwhite (56 vs. 33%), aged ≥75 years (40 vs. 26%), in the lowest quartile for household income (31 vs. 25%), have one or more comorbidities (87 vs. 70%), treated at a nonteaching hospital (46 vs. 25%), and have a concomitant diagnosis of obstruction, perforation, or bleeding (30 vs. 6%). They had longer total length of stay (LOS; 16 vs. 9 days), longer median postoperative stays (10 vs. 9 days), higher in-hospital mortality (8 vs. 3%), and were less likely to be discharged home (63 vs. 82%). EDSx was more expensive ($125,300 vs. $83,604). EDSx was associated with a lower likelihood of discharge to home (odds ratio 0.52, 95% CI 0.43-0.62). CONCLUSIONS Nationally, 12% of GC surgeries are performed after emergency department admission, which occurs more frequently in vulnerable populations and results in worse outcomes. Understanding factors leading to increased EDSx and developing strategies to decrease EDSx may improve GC surgery outcomes.
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Affiliation(s)
- Ian Solsky
- Department of Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA.
| | - Patricia Friedmann
- Department of Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Peter Muscarella
- Department of Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Haejin In
- Department of Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
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