The Primary Care Unit, Department of Public Health and Primary Care, Institute of Public Health, Forvie Site, Robinson Way, University of Cambridge, Cambridge CB2 0SR, UK.
University of Exeter, College House, St Luke's Campus, Exeter EX2 4TE, UK.
Nat Rev Clin Oncol. 2017 Jan;14(1):45-56. doi: 10.1038/nrclinonc.2016.155. Epub 2016 Oct 11.
Many patients with cancer are diagnosed through an emergency presentation, which is associated with inferior clinical and patient-reported outcomes compared with those of patients who are diagnosed electively or through screening. Reducing the proportion of patients with cancer who are diagnosed as emergencies is, therefore, desirable; however, the optimal means of achieving this aim are uncertain owing to the involvement of different tumour, patient and health-care factors, often in combination. Most relevant evidence relates to patients with colorectal or lung cancer in a few economically developed countries, and defines emergency presentations contextually (that is, whether patients presented to emergency health-care services and/or received emergency treatment shortly before their diagnosis) as opposed to clinically (whether patients presented with life-threatening manifestations of their cancer). Consistent inequalities in the risk of emergency presentations by patient characteristics and cancer type have been described, but limited evidence is available on whether, and how, such presentations can be prevented. Evidence on patients' symptoms and health-care use before presentation as an emergency is sparse. In this Review, we describe the extent, causes and implications of a diagnosis of cancer following an emergency presentation, and provide recommendations for public health and health-care interventions, and research efforts aimed at addressing this under-researched aspect of cancer diagnosis.
许多癌症患者是通过急诊就诊被诊断出来的，与通过择期或筛查被诊断的患者相比，他们的临床和患者报告结局较差。因此，减少急诊就诊被诊断为癌症的患者比例是理想的；然而，由于涉及不同的肿瘤、患者和医疗保健因素，通常是多种因素的综合作用，实现这一目标的最佳方法尚不确定。大多数相关证据与少数几个经济发达国家的结直肠癌或肺癌患者有关，并将急诊就诊定义为特定情境下的就诊（即患者是否到急诊医疗服务就诊，以及/或在确诊前是否接受了紧急治疗），而不是临床意义上的就诊（即患者是否出现危及生命的癌症表现）。已描述了患者特征和癌症类型与急诊就诊风险之间的一致不平等现象，但关于此类就诊是否可以预防以及如何预防，证据有限。关于患者在急诊就诊前的症状和医疗保健使用情况的证据很少。在这篇综述中，我们描述了在急诊就诊后被诊断为癌症的程度、原因和影响，并就公共卫生和医疗保健干预措施以及旨在解决这一癌症诊断研究不足方面的研究工作提出了建议。
