A Systematic Review of Emergency Department Use Among Cancer Patients

Abstract

Background Recent reports call for reductions in costly and potentially avoidable services such as emergency department (ED) visits. Providing high-quality and safe care for oncology patients remains challenging for ED providers given the diversity of patients seeking care and the unpredictable clinical environment. While ED use by oncology patients is appropriate for acute health concerns, some ED visits may be preventable with well-coordinated care and adequate symptom management. Objective The aim of this study was to summarize available evidence regarding the incidence, predictors of, and reasons for ED visits among oncology patients. Methods Keyword/MeSH term searches were conducted using 4 online databases. Inclusion criteria were publication date between April 1, 2003, and December 5, 2014; sample size of 50 or more; and report of the incidence or predictors of ED use among oncology patients. Results The 15 studies that met criteria varied in study aim, design, and time frames for calculating ED utilization rates. The incidence of ED visits among oncology patients ranged from 1% to 83%. The 30-day standardized visit rate incidence ranged from 1% to 12%. Collectively, the studies lack population-based estimates for all cancers combined. Conclusions The studies included in this review suggest that rates of ED use among cancer patients exceed those of the general population. However, the extent of ED use by oncology patients and the reasons for ED visits remain understudied. Implications for Practice Nurses are involved in the treatment of cancer, patient education, and symptom management. Nurses are well positioned to develop patient-centered treatment and care coordination plans to improve quality of care and reduce ED visits.

Hospitalisations and emergency department visits in cancer patients receiving systemic therapy: Systematic review and meta-analysis

“…ture as previously reported byLash et al, 2017, and with only 14% of studies in our review providing this data. The reason we only identified a handful of trials reporting frequency of emergency department visits and hospitalisations is likely due to the fact that commonly used adverse event reporting systems such as the Common Terminology Criteria for Adverse Events (CTCAE; National Cancer Institute, 2010) do not report ED visits or hospitalisation events specifically or separately.…”

“…High rates of emergency department visits in patients with cancer during treatment have important ramifications for both patient care and resource use. We need to understand the characteristics of these visits more fully, but they are rarely reported in the literature as previously reported by Lash et al, , and with only 14% of studies in our review providing this data. The reason we only identified a handful of trials reporting frequency of emergency department visits and hospitalisations is likely due to the fact that commonly used adverse event reporting systems such as the Common Terminology Criteria for Adverse Events (CTCAE; National Cancer Institute, ) do not report ED visits or hospitalisation events specifically or separately.…”

Emergency department use by recently diagnosed cancer patients in California

“…These findings suggest that ED use by cancer patients is more than double that of the US general population and is higher than previously estimated for cancer patients. 10,24 In 2010, about 21% of the US population visited the ED, compared with 44% of cancer patients in the same time period. 24 Although persons with greater medical need, such as those with cancer, inevitably require more health services, new approaches are needed to explore the extent to which some of these visits by cancer patients could be prevented by providing care in other settings.…”

“…Reports to date that have described ED use have focused on different cancers, which makes comparisons across studies difficult. 10 Moreover, the time frames of interest and the type of event after which ED use is evaluated (ie, diagnosis or treatment) are inconsistent in the existing literature. 10 Some studies quantifying ED use excluded patients admitted to the hospital after an ED visit.…”

“…10 Moreover, the time frames of interest and the type of event after which ED use is evaluated (ie, diagnosis or treatment) are inconsistent in the existing literature. 10 Some studies quantifying ED use excluded patients admitted to the hospital after an ED visit. 11,12 Taken together, these studies do not provide a clear overview of the extent of ED use by cancer patients or the amount of cancer-related care provided by EDs.…”