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.