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Mitchell ED, Pickwell-Smith B, Macleod U. Risk factors for emergency presentation with lung and colorectal cancers: a systematic review. BMJ Open. 2015;5(4):e006965doi: 10.1136/bmjopen-2014-006965.
Mitchell, E. D., Pickwell-Smith, B., & Macleod, U. (2015). Risk factors for emergency presentation with lung and colorectal cancers: a systematic review. BMJ open, 5(4), e006965. https://doi.org/10.1136/bmjopen-2014-006965
Mitchell, Elizabeth D, et al. "Risk factors for emergency presentation with lung and colorectal cancers: a systematic review." BMJ open vol. 5,4 (2015): e006965. doi: https://doi.org/10.1136/bmjopen-2014-006965
Mitchell ED, Pickwell-Smith B, Macleod U. Risk factors for emergency presentation with lung and colorectal cancers: a systematic review. BMJ Open. 2015 Apr 02;5(4):e006965. doi: 10.1136/bmjopen-2014-006965. PMID: 25838506; PMCID: PMC4390717.
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BMJ Open. 2015 Apr 02;5(4):e006965. doi: 10.1136/bmjopen-2014-006965.

Risk factors for emergency presentation with lung and colorectal cancers: a systematic review.

BMJ open

Elizabeth D Mitchell, Benjamin Pickwell-Smith, Una Macleod

Affiliations

  1. Centre for Health Services Research, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.
  2. Acute General Medicine, John Radcliffe Hospital, Oxford University Hospitals, Oxford, UK.
  3. Supportive Care, Early Diagnosis and Advanced disease (SEDA) Research Group, Centre for Health and Population Sciences, Hull York Medical School, University of Hull, Hull, UK.

PMID: 25838506 PMCID: PMC4390717 DOI: 10.1136/bmjopen-2014-006965

Abstract

OBJECTIVE: To identify patient and practitioner factors that influence cancer diagnosis via emergency presentation (EP).

DESIGN: Systematic review.

DATA SOURCES: MEDLINE, EMBASE, CINAHL, EBM Reviews, Science and Social Sciences Citation Indexes, Conference Proceedings Citation Index-Science and Conference Proceedings Citation Index-Social Science and Humanities. Searches were undertaken from 1996 to 2014. No language restrictions were applied.

STUDY SELECTION: Studies of any design assessing factors associated with diagnosis of colorectal or lung cancer via EP, or describing an intervention to impact on EP, were included. Studies involving previously diagnosed cancer patients, assessing only referral pathway effectiveness, outcomes related to diagnosis or post-EP management were excluded. The population was individual or groups of adult patients or primary care practitioners. Two authors independently screened studies for inclusion.

RESULTS: 22 studies with over 200,000 EPs were included, most providing strong evidence. Five were graded 'insufficient', primarily due to missing information rather than methodological weakness. Older patient age was associated with EP for lung and colorectal cancers (OR 1.11-11.03 and 1.19-5.85, respectively). Women were more at risk of EP for lung but not colorectal cancer. Higher deprivation increased the likelihood of lung cancer EP, but evidence for colorectal was less conclusive. Being unmarried (or divorced/widowed) increased the likelihood of EP for colorectal cancer, which was also associated with pain, obstruction and weight loss. Lack of a regular source of primary care, and lower primary care use were positively associated with EP. Only three studies considered practitioner factors, two involving diagnostic tests. No conclusive evidence was found.

CONCLUSIONS: Patient-related factors, such as age, gender and deprivation, increase the likelihood of cancer being diagnosed as the result of an EP, while cancer symptoms and patterns of healthcare utilisation are also relevant. Further work is needed to understand the context in which risk factors for EP exist and influence help-seeking.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Keywords: Colorectal cancer; Early diagnosis; Lung cancer; PRIMARY CARE

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