title: Risk factors for emergency presentation with lung and colorectal cancers: a systematic review.
abstract: OBJECTIVE
  To identify patient and practitioner factors that influence cancer diagnosis via emergency presentation (EP).
  
  
  METHODS
  Systematic review.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
authors.affiliation: Centre for Health Services Research, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.
authors.forename: Elizabeth D
authors.initials: ED
authors.lastname: Mitchell
authors.affiliation: Acute General Medicine, John Radcliffe Hospital, Oxford University Hospitals, Oxford, UK.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Pickwell-Smith
authors.affiliation: Supportive Care, Early Diagnosis and Advanced disease (SEDA) Research Group, Centre for Health and Population Sciences, Hull York Medical School, University of Hull, Hull, UK.
authors.forename: Una
authors.initials: U
authors.lastname: Macleod
mesh_terms: D015179:Colorectal Neoplasms / Q000150:complications / Q000175:diagnosis*; D004630:Emergencies; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications / Q000175:diagnosis*; D008297:Male; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012307:Risk Factors; D012959:Socioeconomic Factors
keywords: Colorectal cancer; Early diagnosis; Lung cancer; PRIMARY CARE
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