Emergency presentation of colorectal cancer at a regional hospital: An alarming trend?

83 ABSTRACT Background: Colorectal cancer is the most common cause of cancerrelated death in nonsmokers in Canada. Age is an important risk factor. Colorectal cancer emergencies occur in 6% to 34% of cases and are associated with higher morbidity and mortality, longer hospital stay, advanced pathologic stage, poor long-term survival, and higher health care costs. Methods: All cases of colorectal cancer at the Vernon Jubilee Hospital over a 1-year period were studied in order to compare emergency and nonemergency presentations. Pa tient demographics, clinical parameters, and outcomes were compared using the Fisher exact test, 2-tailed student t test, or Wilcoxon signed rank test. A probability value of < .05 was considered significant. Results: During the study period, 75 patients (mean age 72.3 years) re quired treatment for colorectal cancer. Of these 75 patients, 32 (43%) presented on an emergency basis; 59% of these 32 emergency patients presented with obstruction, 9% with perforation, and 34% with hemorrhage. Nonemergency patients did not present with any of these concerns. Sixty-nine percent of the emergency patients had previously undergone a colonoscopy, but none within the previous year compared with 95% of the nonemergency pa tients who had within the previous year. The length of stay for emergen cy patients was 24 days compared with 11 days for nonemergency pa tients (P < .05). In addition, 25% of emergency patients required subse quent placement in a long-term care facility compared with only 2% of nonemergency patients who re quir ed such care after (P < .05). Emergency patients also had a worse over all pathologic stage (2.8 vs 2.0, P< .05), had a worse T stage (3.2 vs 2.5, P < .05), and were more likely to present with metastases (28% vs 7%, P < .05) and positive surgical margins (13% vs 0%, P < .05). Conclusions: Emergency patients had worse outcomes than nonemergency patients, in agreement with findings in the literature, although the emergency presentation rate of 43% was higher than rates seen in the literature. This may be due to the high proportion of those aged 65 and older in Vernon (22% vs 14.6% in the province as a whole), which offers a peek into BC’s future over the next 25 to 30 years as the number of people in this age group is projected to increase to 24% by 2036. The pros pect of an aging population and the results of this study both support establishing a provincial screening program to reduce the costly incidence of colorectal cancer emergencies.