SAN FRANCISCO—More than 40% of colorectal cancer patients diagnosed in California between 2010 and 2015 had at least one ER visit prior to their diagnosis, many within the preceding year, suggesting that ER visits present an opportunity to promote CRC screening.
CRC screening in conventional settings has left something to be desired, and “other widely used healthcare settings may be suitable targets for intervention,” said Afsaneh Barzi, MD, PhD, of City of Hope National Comprehensive Cancer Center, in Duarte, Calif., who along with her co-investigators “explored patterns of emergency room use prior to the diagnosis of CRC to assess the opportunity for screening intervention triggered by these visits.”
Presenting the findings at the 2023 ASCO GI Cancers Symposium (abstract 79), Dr. Barzi noted that “the emergency room is the point of access to healthcare resources for many patients.” While she acknowledged that “it is not realistic to expect ER physicians to address all the healthcare needs of patients, ... building a navigation process to direct patients to screening resources after their emergency room visit can optimize access to screening for these patients.”
The study explored ER utilization in patients with CRC before their diagnosis. Investigators linked the records of 57,876 people with diagnosis of CRC with hospital discharge records and found:
- 69% had at least one ER visit;
- 31% had three or more ER visits;
- 41% had at least one ER visit before their diagnosis of CRC;
- 25% visited an ER within one year of their CRC diagnosis; and
- 25% of patients had a diagnostic code related to a gastrointestinal complaint.
The median age of patients who had ER visits was slightly younger than those without ER visits (66 vs. 68 years), but the number of ER visits did not differ between patients 50 and younger and those older than 50 years. There was no significant difference in the stage at presentation between those with a prior ER visit and those without.
Emergency room visits before CRC diagnosis were significantly more likely for patients in the lowest versus highest socioeconomic class (64% vs. 56%); for patients with federal and state-funded insurance versus private insurance (64% vs. 55%); and for non-Hispanic Blacks versus non-Hispanic whites (69% vs. 60%).
“We have plans in place to interview ER providers to better understand the barriers in the ER for any potential future interventions,” Dr. Barzi said.
Neil Stollman, MD, the chief of gastroenterology at Alta Bates Summit Medical Center in Oakland, Calif., and an associate clinical professor of medicine at the University of California, San Francisco, said he could not draw conclusions from the study’s findings without a comparison with people without CRC or those with other cancers. As he noted, ER visits are common among adults over 50. He commented, “While it would be nice to use the ER to promote general preventive health, that’s not really what it’s for.”
However, he acknowledged, “anytime we’ve got ‘hands on’ a patient, it’s a good idea to get as much good stuff done as possible. … Note that 25% had a GI complaint, so [depending on diagnosis] they should be referred to a gastroenterologist. … In general, we do that poorly. Navigators can facilitate that process, though resources (cost) can be an issue.”
—Caroline Helwick
Dr. Barzi reported financial relationships with Bayer, Biotheranostics, Cardiff, Daiichi Sankyo/AstraZeneca, Helsinn/QED and Merrion. Dr. Stollman reported no relevant financial disclosures.
This article is from the April 2023 print issue.