Diagnosis of cancer as an emergency: a critical review of current evidence

Key Points The diagnosis of cancer as an emergency is associated with a substantially worse prognosis; however, this represents an understudied problem, with evidence examining its frequency and aetiology limited to a few developed countries Most available evidence defines diagnosis of cancer as an...

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Vydáno v:	Nature reviews. Clinical oncology Ročník 14; číslo 1; s. 45 - 56
Hlavní autoři:	Zhou, Yin, Abel, Gary A., Hamilton, Willie, Pritchard-Jones, Kathy, Gross, Cary P., Walter, Fiona M., Renzi, Cristina, Johnson, Sam, McPhail, Sean, Elliss-Brookes, Lucy, Lyratzopoulos, Georgios
Médium:	Journal Article
Jazyk:	angličtina
Vydáno:	London Nature Publishing Group UK 01.01.2017 Nature Publishing Group
Témata:	692/4028/67/2322 692/499 692/700/139 Adolescent Adult Age Factors Cancer diagnosis Child Child, Preschool Early Detection of Cancer Emergencies Emergency Treatment - statistics & numerical data Forecasts and trends General Practice - statistics & numerical data Humans Infant Infant, Newborn Karnofsky Performance Status Medical emergencies Medicine & Public Health Neoplasm Grading Neoplasm Staging Neoplasms - complications Neoplasms - diagnosis Oncology Patient Acceptance of Health Care - statistics & numerical data Primary Health Care - statistics & numerical data Public health administration review-article Risk Factors Sex Factors Socioeconomic Factors Statistics Young Adult
ISSN:	1759-4774, 1759-4782, 1759-4782
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Abstract	Key Points The diagnosis of cancer as an emergency is associated with a substantially worse prognosis; however, this represents an understudied problem, with evidence examining its frequency and aetiology limited to a few developed countries Most available evidence defines diagnosis of cancer as an emergency contextually instead of employing clinical criteria regarding presentation severity, and uses administrative data as opposed to reviews of medical records An emergency diagnosis of cancer often has a complex aetiology, involving tumour, patient and health-care related factors; evidence on the role of tumour and health-care related factors is particularly sparse Studying variations in the risk of emergency presentations by prior health-care use and related symptoms can elucidate how some emergency presentations could potentially be prevented Sociodemographic inequalities in the risks of emergency presentation underline the contribution of psychosocial factors and the potential for targeting of public health campaigns regarding cancer symptoms Optimising screening can help to reduce emergency presentations of patients with colorectal cancer Patients diagnosed with cancer through an emergency presentation have worse outcomes compared with those in whom cancer is diagnosed through other routes; therefore, reducing the number of patients presenting as an emergency with cancer will improve patients' outcomes. In this Review, the authors describe the available evidence in this area, and provide recommendations for future research, clinical practice and public health policy. 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.
AbstractList	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. 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.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. Key Points The diagnosis of cancer as an emergency is associated with a substantially worse prognosis; however, this represents an understudied problem, with evidence examining its frequency and aetiology limited to a few developed countries Most available evidence defines diagnosis of cancer as an emergency contextually instead of employing clinical criteria regarding presentation severity, and uses administrative data as opposed to reviews of medical records An emergency diagnosis of cancer often has a complex aetiology, involving tumour, patient and health-care related factors; evidence on the role of tumour and health-care related factors is particularly sparse Studying variations in the risk of emergency presentations by prior health-care use and related symptoms can elucidate how some emergency presentations could potentially be prevented Sociodemographic inequalities in the risks of emergency presentation underline the contribution of psychosocial factors and the potential for targeting of public health campaigns regarding cancer symptoms Optimising screening can help to reduce emergency presentations of patients with colorectal cancer Patients diagnosed with cancer through an emergency presentation have worse outcomes compared with those in whom cancer is diagnosed through other routes; therefore, reducing the number of patients presenting as an emergency with cancer will improve patients' outcomes. In this Review, the authors describe the available evidence in this area, and provide recommendations for future research, clinical practice and public health policy. 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.
Audience	Academic
Author	Abel, Gary A. Pritchard-Jones, Kathy Walter, Fiona M. Lyratzopoulos, Georgios Johnson, Sam Zhou, Yin Elliss-Brookes, Lucy Renzi, Cristina McPhail, Sean Gross, Cary P. Hamilton, Willie
Author_xml	– sequence: 1 givenname: Yin surname: Zhou fullname: Zhou, Yin organization: Department of Public Health and Primary Care, The Primary Care Unit, Institute of Public Health, Forvie Site, Robinson Way, University of Cambridge – sequence: 2 givenname: Gary A. surname: Abel fullname: Abel, Gary A. organization: Department of Public Health and Primary Care, The Primary Care Unit, Institute of Public Health, Forvie Site, Robinson Way, University of Cambridge, University of Exeter, College House – sequence: 3 givenname: Willie surname: Hamilton fullname: Hamilton, Willie organization: University of Exeter, College House – sequence: 4 givenname: Kathy surname: Pritchard-Jones fullname: Pritchard-Jones, Kathy organization: Institute of Child Health, University College London, University College London Partners Academic Health Science Network – sequence: 5 givenname: Cary P. surname: Gross fullname: Gross, Cary P. organization: Section of General Medicine, Cancer Outcomes Public Policy and Effectiveness Research (COPPER) Center, Yale University School of Medicine – sequence: 6 givenname: Fiona M. surname: Walter fullname: Walter, Fiona M. organization: Department of Public Health and Primary Care, The Primary Care Unit, Institute of Public Health, Forvie Site, Robinson Way, University of Cambridge – sequence: 7 givenname: Cristina surname: Renzi fullname: Renzi, Cristina organization: Department of Epidemiology and Public Health, Health Behaviour Research Centre, University College London – sequence: 8 givenname: Sam surname: Johnson fullname: Johnson, Sam organization: National Cancer Registration and Analysis Service, Public Health England Zone A, 2nd Floor, Skipton House – sequence: 9 givenname: Sean surname: McPhail fullname: McPhail, Sean organization: National Cancer Registration and Analysis Service, Public Health England Zone A, 2nd Floor, Skipton House – sequence: 10 givenname: Lucy surname: Elliss-Brookes fullname: Elliss-Brookes, Lucy organization: National Cancer Registration and Analysis Service, Public Health England Zone A, 2nd Floor, Skipton House – sequence: 11 givenname: Georgios surname: Lyratzopoulos fullname: Lyratzopoulos, Georgios email: y.lyratzopoulos@ucl.ac.uk organization: Department of Public Health and Primary Care, The Primary Care Unit, Institute of Public Health, Forvie Site, Robinson Way, University of Cambridge, Department of Epidemiology and Public Health, Health Behaviour Research Centre, University College London, National Cancer Registration and Analysis Service, Public Health England Zone A, 2nd Floor, Skipton House
BackLink	https://www.ncbi.nlm.nih.gov/pubmed/27725680$$D View this record in MEDLINE/PubMed
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Snippet	Key Points The diagnosis of cancer as an emergency is associated with a substantially worse prognosis; however, this represents an understudied problem, with... Many patients with cancer are diagnosed through an emergency presentation, which is associated with inferior clinical and patient-reported outcomes compared...
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Title	Diagnosis of cancer as an emergency: a critical review of current evidence
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