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dc.contributor.authorRenzi, Cristinaen
dc.contributor.authorLyratzopoulos, Georgiosen
dc.contributor.authorHamilton, Willieen
dc.contributor.authorMaringe, Camilleen
dc.contributor.authorRachet, Bernarden
dc.date.accessioned2019-06-21T09:14:48Z
dc.date.available2019-06-21T09:14:48Z
dc.date.issued2019-05-15en
dc.identifier.issn1472-6963
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/293835
dc.description.abstractBACKGROUND: One 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). METHODS: We 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. RESULTS: Colon 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. CONCLUSIONS: Patients 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.
dc.description.sponsorshipEarly Diagnosis Advisory Group (EDAG), Cancer Research UK [C48748/ A18667]. BMA TP Gunton research grant. This research is linked to the CanTest Collaborative, which is funded by Cancer Research UK (C8640/ A23385), of which WH is Director and GL an Associate Director
dc.languageengen
dc.publisherBioMed Central
dc.rightsAttribution 4.0 International*
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/*
dc.subjectChronic conditionsen
dc.subjectColon canceren
dc.subjectComorbidityen
dc.subjectDiagnosisen
dc.subjectEmergency presentationsen
dc.subjectSymptomsen
dc.titleContrasting effects of comorbidities on emergency colon cancer diagnosis: a longitudinal data-linkage study in England.en
dc.typeArticle
prism.issueIdentifier1en
prism.number311en
prism.publicationDate2019en
prism.publicationNameBMC Health Services Researchen
prism.volume19en
dc.identifier.doi10.17863/CAM.40947
dcterms.dateAccepted2019-04-08en
rioxxterms.versionofrecord10.1186/s12913-019-4075-4en
rioxxterms.versionVoR*
rioxxterms.licenseref.urihttp://creativecommons.org/licenses/by/4.0/en
rioxxterms.licenseref.startdate2019-05-15en
dc.contributor.orcidLyratzopoulos, Georgios [0000-0002-2873-7421]
dc.identifier.eissn1472-6963
rioxxterms.typeJournal Article/Reviewen
cam.issuedOnline2019-05-15en
dc.identifier.urlhttps://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-019-4075-4en


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Attribution 4.0 International
Except where otherwise noted, this item's licence is described as Attribution 4.0 International