Patterns of Colorectal Cancer Diagnosis in Older Adults: A SEER-Medicare Analysis of Health and Economic Impact of Missed Screening Opportunities.
OBJECTIVE To assess how diagnostic pathways affect clinical outcomes and healthcare costs among older adults diagnosed with colorectal cancer (CRC). SUMMARY OF BACKGROUND DATA Many CRC cases in the United State are diagnosed during an emergency presentation, which have been linked to worse outcomes. Understanding how diagnostic routes may impact a cancer diagnosis may be critical for improving care. METHODS We analyzed SEER-Medicare data (2005-2019) for patients aged ≥ 65 years with CRC. Diagnostic routes were classified as screening, inpatient/outpatient (IP/OP), or emergency presentation (ER) based on encounters within 30-day to 6-months before diagnosis. Multivariable regression evaluated associations between route and outcomes. RESULTS Among 79,251 CRC patients (colon: 72.4%, rectum: 27.6%), diagnoses occurred via ER (13.7%), IP/OP (60.6%), and screening (25.7%). Compared with screened patients, ER-diagnosed patients were older (median age: 79 vs. 75), had higher comorbidity (22.5% vs. 8.1%), and lower income (29.1% vs. 23.9%). ER diagnosis was associated with urgent surgery (59.7% vs. 20.1%), complications (29.8% vs. 14.2%), extended stay (37.2% vs. 14%), inpatient mortality (7.4% vs. 2.1%), lower discharge to home (32.2% vs. 62.4%), and higher 90-day mortality (16.8% vs. 5%). Multivariable analysis confirmed ER diagnosis as the strongest predictor of stage IV disease (OR 1.75, 95% CI: 1.66-1.84), urgent surgery (OR 5.14, 95%CI: 4.83-5.48), and 90-day mortality (OR 1.80, 95%CI: 1.62-1.99; all p < 0.001). Costs were higher for ER versus screening: index surgery ($13,802 vs. $11,458) and postoperative care ($9,470 vs. $3,655). CONCLUSIONS Emergency CRC diagnosis was associated with worse outcomes and higher costs, emphasizing the need for targeted screening and earlier detection strategies.