Addressing New Diagnostic and Treatment Challenges Associated With a New Age of Cancer Treatment

Seo

2021

Cancer

BACKGROUND Emergency department (ED) utilization and emergency admissions by patients with cancer have increased. The authors aimed to evaluate the characteristics of patients with cancer admitted through the ED and determine whether cancer types are related to in‐hospital mortality. METHODS The National Emergency Department Information System database of patients visiting EDs in South Korea between 2016 and 2017 was analyzed. Among 6,179,088 adult patients who presented to an ED with nontraumatic medical illness, patients with cancer were identified. The primary outcome was in‐hospital mortality. RESULTS Patients with cancer accounted for 6.8% of ED visits, and 239,630 patients (57.0%) were admitted to the hospital (intensive care unit [ICU], 9.5%; others, 90.5%). The prevalent cancers requiring hospitalization were lung cancer (15.7%), liver cancer (14.2%), and colon cancer (11.6%). The commonest reasons for admission other than cancer‐related medical problems (41.4%) were pneumonia (4.8%) and hepatobiliary infection (2.8%). Overall in‐hospital mortality was 16.1% (ICU, 28.3%; general wards, 14.8%); lung cancer (22.9%), liver cancer (19.7%), and leukemia/multiple myeloma (17.8%) showed the highest mortality rates. The highest odds for mortality were for lung cancer (adjusted odds ratio [OR], 2.227; 95% confidence interval [CI], 2.124‐2.335; P < .001) and liver cancer (adjusted OR, 1.839; 95% CI, 1.751‐1.930; P < .001), which were referenced to genitourinary cancer by multivariable logistic regression analysis. CONCLUSIONS More than half of the patients with cancer visiting EDs were admitted to the hospital with a mortality rate of 16.1%. Physicians treating patients with cancer and policymakers and planners designing health systems should understand the different prevalences and outcomes of oncological emergencies by cancer type to improve patient care.

Section: Introductionmentioning

confidence: 99%

Types of cancer and outcomes in patients with cancer requiring admission from the emergency department: A nationwide, population‐based study, 2016‐2017

Seo

2021

Cancer

“…For example, select centers in the United States have established specialized cancer EDs or urgent care centers with expertise in the management of acute cancers and the complications of chronic cancer treatment such as chemotherapeutic toxicity 50–53 . Strengthening the link between oncology and emergency medicine teams with a multidisciplinary approach could improve the quality, efficiency, and continuity of care for these patients 10,50,54–56 . The Comprehensive Oncologic Emergencies Research Network (CONCERN) was established with support from the National Cancer Institute to expand the knowledge around the treatment of oncologic emergencies in the emergency medicine setting by facilitating collaborations across oncology and emergency medicine 57 …”

Section: Discussionmentioning

confidence: 99%

Diagnosis of cancer in the Emergency Department: A scoping review

et al. 2023

Self Cite

Background The Emergency Department (ED) plays a key role in the identification and care of acute medical conditions, including cancer. In this scoping review, we aimed to determine the role of the ED in the acute diagnosis of cancer. Methods We conducted a scoping review of articles according to Preferred Reporting Items for Systematic Review and Meta‐Analyses (PRISMA) using PubMed and Google Scholar. We screened studies of adults with a new diagnosis of cancer in the ED. We included randomized control trials, prospective, retrospective, and cross‐sectional observational studies, and case reports published in English since 2000. We grouped the articles into categories based on their objectives and findings. Results Of the 4459 articles, we included 47 in the review. The identified studies fell into three major categories: (1) studies describing the incidental diagnosis of cancer in the ED (n = 11, 23%), (2) studies characterizing the acute initial presentation of cancer in the ED (n = 19, 41%), and (3) studies describing the ED as a pathway to cancer diagnosis in the healthcare system (n = 17, 36%). Across the studies, cancer diagnoses in the ED were more likely in patients with higher comorbidities, occurred at later stages, and resulted in worse survival rates. Conclusions The ED plays a prominent role in the initial diagnosis of cancer. Efforts must be made to integrate the ED within the cancer care continuum.

“…Colitis, most commonly reported serious irAE (grade 3 or greater) in previous studies, was only diagnosed in two of the ED patients [ 16 ]. Previous emergency medicine publications have identified rash and diarrhea as the most common toxicities presenting to the ED [ 12 , 13 , 14 , 17 ], only recorded in two patients. One possible reason for this discrepancy is that the patient or prescriber may be more likely to recognize these symptoms as related to an irAE and care may have been initiated as an outpatient or with a direct admission, circumventing the ED.…”

Section: Discussionmentioning

confidence: 99%

“…Patients with advanced cancer may present to the ED for numerous reasons including disease progression, infections, pain crisis. This places a challenge on identifying a first presentation of an irAE among other potential causes of generalized fatigue or pain [ 12 , 13 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

Emergency Department Utilization for Patients Receiving Immune Checkpoint Inhibitors: A Retrospective Analysis of Identification and Outcomes for Those Presenting for Immune-Related Adverse Events

2020

Background: Immune-related adverse events (iRAEs) are known complications of immune checkpoint inhibitors (ICIs). Early identification and management leads to improved morbidity and mortality. This study seeks to address our center’s experience with iRAEs in the emergency department (ED). Methods: We performed a retrospective review of patients treated with ICIs in 2018 and 2019 for any indication. All diagnoses of iRAEs were recorded. For all patients who presented to the ED following administration of an ICI, we assessed whether the presenting symptoms were eventually diagnosed as an iRAE. We assessed disposition, time to initiation of corticosteroids and outcomes in these patients. Results: 351 evaluable patients were treated with an ICI, 129 patients (37%) had at least one presentation to the ED, 17 of whom presented with symptoms due to a new iRAE. New iRAE diagnoses were broad, occurred after median 2 cycles, majority irAEs were grade 3 or higher (70.6%), and two patients died due to toxicity. Twelve patients were admitted to the hospital during initial presentation or at follow-up, four required ICU care. All patients required immunosuppressive therapy, and only three were later re-challenged with an ICI. Of the patients who were admitted to the hospital, median time to first dose of corticosteroid was 30.5 h (range 1–269 h). Conclusions: Patients on ICI have a significant risk of requiring an ED visit. A notable proportion of iRAEs have their first presentation at the ED and often can present in a very nonspecific manner. A standardized approach in the ED at the time of presentation may lead to improved identification and management of these patients.