Gastric cancer diagnosis after presentation to the ED: The independent association of presenting location and outcomes

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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. Summary: Demographics, treatment, and outcomes of gastric adenocarcinoma patients at a single center whose diagnosis was prompted by an emergency department (ED) visit were compared to that of patients diagnosed in non-ED settings. 52% of patients had an ED visit prompting their diagnosis, which was associated with an increased mortality risk.

Original languageEnglish (US)
JournalAmerican Journal of Surgery
DOIs
StateAccepted/In press - Jan 1 2017

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Stomach Neoplasms
Hospital Emergency Service
Mortality
Insurance Coverage
Comorbidity
Stomach
Adenocarcinoma
Demography
Hemorrhage
Neoplasms

Keywords

  • Cancer diagnosis
  • Emergency department
  • Gastric cancer

ASJC Scopus subject areas

  • Surgery

Cite this

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title = "Gastric cancer diagnosis after presentation to the ED: The independent association of presenting location and outcomes",
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. Summary: Demographics, treatment, and outcomes of gastric adenocarcinoma patients at a single center whose diagnosis was prompted by an emergency department (ED) visit were compared to that of patients diagnosed in non-ED settings. 52{\%} of patients had an ED visit prompting their diagnosis, which was associated with an increased mortality risk.",
keywords = "Cancer diagnosis, Emergency department, Gastric cancer",
author = "Ian Solsky and Rapkin, {Bruce D.} and Kristen Wong and Patricia Friedmann and Peter Muscarella and Haejin In",
year = "2017",
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day = "1",
doi = "10.1016/j.amjsurg.2017.10.030",
language = "English (US)",
journal = "American Journal of Surgery",
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T1 - Gastric cancer diagnosis after presentation to the ED

T2 - The independent association of presenting location and outcomes

AU - Solsky, Ian

AU - Rapkin, Bruce D.

AU - Wong, Kristen

AU - Friedmann, Patricia

AU - Muscarella, Peter

AU - In, Haejin

PY - 2017/1/1

Y1 - 2017/1/1

N2 - 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. Summary: Demographics, treatment, and outcomes of gastric adenocarcinoma patients at a single center whose diagnosis was prompted by an emergency department (ED) visit were compared to that of patients diagnosed in non-ED settings. 52% of patients had an ED visit prompting their diagnosis, which was associated with an increased mortality risk.

AB - 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. Summary: Demographics, treatment, and outcomes of gastric adenocarcinoma patients at a single center whose diagnosis was prompted by an emergency department (ED) visit were compared to that of patients diagnosed in non-ED settings. 52% of patients had an ED visit prompting their diagnosis, which was associated with an increased mortality risk.

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KW - Gastric cancer

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