{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T18:59:38Z","timestamp":1790621978652,"version":"4.1.0"},"reference-count":40,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T00:00:00Z","timestamp":1784160000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T00:00:00Z","timestamp":1784160000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Surgical Oncology"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To assess how diagnostic pathways affect clinical outcomes and healthcare costs among older adults diagnosed with colorectal cancer (CRC).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Summary of Background Data<\/jats:title>\n                    <jats:p>Many CRC cases in the United State are diagnosed during an emergency presentation, which have been\u00a0linked to worse outcomes. Understanding how diagnostic routes may impact a cancer diagnosis may be\u00a0critical for improving care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analyzed SEER\u2010Medicare data (2005\u20132019) for patients aged \u2265\u200965 years with CRC. Diagnostic routes were classified as screening, inpatient\/outpatient (IP\/OP), or emergency presentation (ER) based on encounters within 30\u2010day to 6\u2010months before diagnosis. Multivariable regression evaluated associations between route and outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      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\u2010diagnosed 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\u2010day 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\u20131.84), urgent surgery (OR 5.14, 95%CI: 4.83\u20135.48), and 90\u2010day mortality (OR 1.80, 95%CI: 1.62\u20131.99; all\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Costs were higher for ER versus screening: index surgery ($13,802 vs. $11,458) and postoperative care ($9,470 vs. $3,655).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Emergency CRC diagnosis was associated with worse outcomes and higher costs, emphasizing the need for targeted screening and earlier detection strategies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jso.70338","type":"journal-article","created":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T09:46:24Z","timestamp":1784195184000},"page":"673-683","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Patterns of Colorectal Cancer Diagnosis in Older Adults: A SEER\u2010Medicare Analysis of Health and Economic Impact of Missed Screening Opportunities"],"prefix":"10.1002","volume":"134","author":[{"given":"Eshetu B.","family":"Worku","sequence":"first","affiliation":[{"name":"Department of Surgery The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center Columbus Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Selamawit A.","family":"Woldesenbet","sequence":"additional","affiliation":[{"name":"Department of Surgery The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center Columbus Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Odysseas P.","family":"Chatzipanagiotou","sequence":"additional","affiliation":[{"name":"Department of Surgery The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center Columbus Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7994-9870","authenticated-orcid":false,"given":"Timothy M.","family":"Pawlik","sequence":"additional","affiliation":[{"name":"Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, Professor of Surgery, Oncology, Health Services Management and Policy The Ohio State University Columbus Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,16]]},"reference":[{"key":"e_1_2_10_2_1","volume-title":"Cancer Facts & Figures 2025","author":"American Cancer Society","year":"2025"},{"key":"e_1_2_10_3_1","unstructured":"National Cancer Institute. Colorectal Cancer Stat Facts. Surveillance Epidemiology and End Results Program accessed August 24 2025 https:\/\/seer.cancer.gov\/statfacts\/html\/colorect.html."},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2025.9147"},{"key":"e_1_2_10_5_1","unstructured":"American Cancer Society. Key statistics for colorectal cancer. Updated April 28 2025 accessed August 24 2025 https:\/\/www.cancer.org\/cancer\/types\/colon-rectal-cancer\/about\/key-statistics.html."},{"key":"e_1_2_10_6_1","unstructured":"Centers for Disease Control and Prevention.Health and Economic Benefits of Colorectal Cancer Interventions. Updated March 2024 accessed September 16 2025 https:\/\/www.cdc.gov\/nccdphp\/priorities\/colorectal-cancer.html."},{"key":"e_1_2_10_7_1","volume-title":"Colorectal Cancer Facts & Figures 2023\u20132025","author":"American Cancer Society","year":"2022"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2025.10618"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2021.6238"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2025.7494"},{"key":"e_1_2_10_11_1","unstructured":"Centers for Disease Control and Prevention. Colorectal Cancer Screening Rates. Updated March 2024. Available from:https:\/\/www.cdc.gov\/cancer\/colorectal\/statistics\/screening_rates.htm."},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10620-024-08762-6"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1158\/1055-9965.EPI-19-1379"},{"key":"e_1_2_10_14_1","volume-title":"Colorectal Cancer Facts & Figures 2020\u20132022","author":"American Cancer Society","year":"2020"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2025.8867"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0135027"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.47806"},{"issue":"1","key":"e_1_2_10_18_1","article-title":"Social Risks and Nonadherence to Recommended Cancer Screening Among US Adults","volume":"7","author":"Sedani A. 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Available at: SEER Incidence Data 1975\u20132021 (cancer.gov) accessed August 23 2025."},{"key":"e_1_2_10_26_1","unstructured":"National Cancer Institute. SEER\u2010Medicare: Medicare enrollment claims and assessment data accessed August 24 2025.healthservices.cancer.gov\/seermedicare\/medicare\/."},{"key":"e_1_2_10_27_1","unstructured":"National Cancer Institute. Overview of the SEER\u2010Medicare data accessed August 24 2025.jstor.org\/stable\/pdf\/3767919.pdf."},{"key":"e_1_2_10_28_1","volume-title":"CDC Social Vulnerability Index (SVI) [Internet]","author":"Centers for Disease Control and Prevention"},{"key":"e_1_2_10_29_1","doi-asserted-by":"publisher","DOI":"10.2202\/1547-7355.1792"},{"key":"e_1_2_10_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejso.2022.06.012"},{"key":"e_1_2_10_31_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2025.0112"},{"key":"e_1_2_10_32_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2023.39848"},{"key":"e_1_2_10_33_1","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.165.18.2129"},{"key":"e_1_2_10_34_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2025.1837"},{"key":"e_1_2_10_35_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.35669"},{"key":"e_1_2_10_36_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.12345"},{"key":"e_1_2_10_37_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2020.26188"},{"key":"e_1_2_10_38_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2023.3345"},{"key":"e_1_2_10_39_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2020.14701"},{"issue":"3","key":"e_1_2_10_40_1","first-page":"e145","article-title":"Optimal Approach to Colorectal Cancer Screening","volume":"21","author":"Wang C.","year":"2025","journal-title":"Gastroenterolog\u00eda y Hepatolog\u00eda"},{"key":"e_1_2_10_41_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2021.5746"}],"container-title":["Journal of Surgical Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jso.70338","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/jso.70338","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jso.70338","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T18:00:16Z","timestamp":1790618416000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/jso.70338"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,16]]},"references-count":40,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,10]]}},"alternative-id":["10.1002\/jso.70338"],"URL":"https:\/\/doi.org\/10.1002\/jso.70338","archive":["Portico"],"relation":{},"ISSN":["0022-4790","1096-9098"],"issn-type":[{"value":"0022-4790","type":"print"},{"value":"1096-9098","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,16]]},"assertion":[{"value":"2026-01-30","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-07","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-16","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}