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Risk factors for emergency presentation with lung and colorectal cancers: A systematic review

Mitchell, Elizabeth D.; Pickwell-Smith, Benjamin; Macleod, Una


Elizabeth D. Mitchell

Benjamin Pickwell-Smith


© 2015, BMJ. All rights reserved. Objective: To identify patient and practitioner factors that influence cancer diagnosis via emergency presentation (EP). Design: Systematic review. Data sources: MEDLINE, EMBASE, CINAHL, EBM Reviews, Science and Social Sciences Citation Indexes, Conference Proceedings Citation Index-Science and Conference Proceedings Citation Index-Social Science and Humanities. Searches were undertaken from 1996 to 2014. No language restrictions were applied. Study selection: Studies of any design assessing factors associated with diagnosis of colorectal or lung cancer via EP, or describing an intervention to impact on EP, were included. Studies involving previously diagnosed cancer patients, assessing only referral pathway effectiveness, outcomes related to diagnosis or post-EP management were excluded. The population was individual or groups of adult patients or primary care practitioners. Two authors independently screened studies for inclusion. Results: 22 studies with over 200 000 EPs were included, most providing strong evidence. Five were graded 'insufficient', primarily due to missing information rather than methodological weakness. Older patient age was associated with EP for lung and colorectal cancers (OR 1.11-11.03 and 1.19-5.85, respectively). Women were more at risk of EP for lung but not colorectal cancer. Higher deprivation increased the likelihood of lung cancer EP, but evidence for colorectal was less conclusive. Being unmarried (or divorced/widowed) increased the likelihood of EP for colorectal cancer, which was also associated with pain, obstruction and weight loss. Lack of a regular source of primary care, and lower primary care use were positively associated with EP. Only three studies considered practitioner factors, two involving diagnostic tests. No conclusive evidence was found. Conclusions: Patient-related factors, such as age, gender and deprivation, increase the likelihood of cancer being diagnosed as the result of an EP, while cancer symptoms and patterns of healthcare utilisation are also relevant. Further work is needed to understand the context in which risk factors for EP exist and influence help-seeking.


Mitchell, E. D., Pickwell-Smith, B., & Macleod, U. (2015). Risk factors for emergency presentation with lung and colorectal cancers: A systematic review. BMJ open, 5(4),

Journal Article Type Article
Acceptance Date Feb 26, 2015
Online Publication Date Apr 2, 2015
Publication Date Apr 2, 2015
Deposit Date Apr 25, 2019
Publicly Available Date Apr 26, 2019
Journal BMJ Open
Print ISSN 2044-6055
Electronic ISSN 2044-6055
Publisher BMJ Publishing Group
Peer Reviewed Peer Reviewed
Volume 5
Issue 4
Article Number e006965
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Copyright Statement
This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See:

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