title: Impact of comorbidity and healthcare utilization on colorectal cancer stage at diagnosis: literature review.
abstract: OBJECTIVE
  Individuals diagnosed with cancer close to death have low access to enrollment in palliative care programs. The purpose of this literature review was to assess the usefulness of pre-diagnostic comorbidity and healthcare utilization as indicators of late-stage colorectal cancer (CRC) diagnosis, to help with early identification of individuals who may benefit from palliative care.
  
  
  METHODS
  A literature search was conducted in relevant databases using title/abstract terms which included "cancer," "stage," "diagnosis," "determinants," "predictors," and "associated." Included studies examined whether comorbidity and/or healthcare utilization had an impact on the stage at which CRC was diagnosed. A standardized data abstraction form was used to assess the eligibility of each study. Thirteen articles were included in the literature review. These studies were assessed and synthesized using qualitative methodology.
  
  
  RESULTS
  We found much heterogeneity among study variables. The findings of this literature review point to the presence of comorbidity and non-emergent healthcare utilization as having no association with late-stage diagnosis. Conversely, emergency room presentation (ERP) was associated with late-stage diagnosis.
  
  
  CONCLUSIONS
  The results of this literature review did not find strong evidence to suggest that comorbidity and healthcare utilization are potential indicators of late-stage diagnosis. However, ERP may be useful as a flag for consideration of prompt referral to palliative care. Additional research is required to identify potential indicators of late-stage diagnosis that may be available in administrative databases, particularly in the area of healthcare utilization.
authors.affiliation: Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada.
authors.forename: Mark
authors.initials: M
authors.lastname: Corkum
authors.forename: Robin
authors.initials: R
authors.lastname: Urquhart
authors.forename: Cynthia
authors.initials: C
authors.lastname: Kendell
authors.forename: Fred
authors.initials: F
authors.lastname: Burge
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Porter
authors.forename: Grace
authors.initials: G
authors.lastname: Johnston
mesh_terms: D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000473:pathology* / Q000628:therapy; D015897:Comorbidity; D003695:Delivery of Health Care / Q000379:methods; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D009367:Neoplasm Staging; D010166:Palliative Care / Q000379:methods
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