Ian Solsky1, Bruce Rapkin2, Kristen Wong1, Patricia Friedmann1, Peter Muscarella1, Haejin In3. 1. Montefiore Medical Center/Albert Einstein College of Medicine, Department of Surgery, Bronx, NY, USA. 2. Montefiore Medical Center/Albert Einstein College of Medicine, Department of Epidemiology and Population Health, Bronx, NY, USA. 3. Montefiore Medical Center/Albert Einstein College of Medicine, Department of Surgery, Bronx, NY, USA. Electronic address: hin@montefiore.org.
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.
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:EDdxpatients 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.
Authors: David Weithorn; Vanessa Arientyl; Ian Solsky; Goyal Umadat; Rebecca Levine; Bruce Rapkin; Jason Leider; Haejin In Journal: J Surg Res Date: 2020-06-17 Impact factor: 2.192