Cancer-related emergency and urgent care: expanding the research agenda

Abstract

Purpose of review Cancer-related emergency department (ED) visits often result in higher hospital admission rates than non-cancer visits. It has been estimated many of these costly hospital admissions can be prevented, yet urgent care clinics and EDs lack cancer-specific care resources to support the needs of this complex population. Implementing effective approaches across different care settings and populations to minimize ED and urgent care visits improves oncologic complication management, and coordinating follow-up care will be particularly important as the population of cancer patients and survivors continues to increase. The National Cancer Institute (NCI) and the Office of Emergency Care (OECR) convened a workshop in December 2021, “Cancer-related Emergency and Urgent Care: Prevention, Management, and Care Coordination” to highlight progress, knowledge gaps, and research opportunities. This report describes the current landscape of cancer-related urgent and emergency care and includes research recommendations from workshop participants to decrease the risk of oncologic complications, improve their management, and enhance coordination of care. Recent findings Since 2014, NCI and OECR have collaborated to support research in cancer-related emergency care. Workshop participants recommended a number of promising research opportunities, as well as key considerations for designing and conducting research in this area. Opportunities included better characterizing unscheduled care services, identifying those at higher risk for such care, developing care delivery models to minimize unplanned events and enhance their care, recognizing cancer prevention and screening opportunities in the ED, improving management of specific cancer-related presentations, and conducting goals of care conversations. Summary Significant progress has been made over the past 7 years with the creation of the Comprehensive Oncologic Emergency Research Network, broad involvement of the emergency medicine and oncology communities, establishing a proof-of-concept observational study, and NCI and OECR’s efforts to support this area of research. However, critical gaps remain.

Variations in Emergency Service Utilization among Cancer Survivors: Results from the Pan-Canadian Experiences of Cancer Patients in Transition Study Survey

“…The higher needs in this age group, which are often less well met compared to other groups, could be one reason for increased ESU, along with differences in treatment regimens with unique side effect profiles, social functioning, and caregiver support in AYA cancer survivors. This population has been historically underrepresented in cancer care quality improvement projects, and gaps exist in our understanding of their needs and experiences [ 17 , 23 ]. Further research will help inform strategies to improve the quality of survivorship care for AYA cancer survivors.…”

Diagnosis of cancer in the Emergency Department: A scoping review

“…The National Cancer Institute has recognized that improved integration of the ED into the continuum of cancer care could lead to better patient management and outcomes. 15 However, there are only limited perspectives on the role of the ED in cancer care. The optimal community management of cancer requires a system‐wide approach, encompassing integration of screening, detection, treatment, and recovery efforts.…”

Emergency department utilization and disposition outcomes by pediatric patients with cancer in Maryland and New York from 2013 to 2017

“…14 More than 40% of pediatric patients with cancer use ED services for cancer-related and unrelated care needs. 10,11,13,15 In addition, about half of ED visits among these patients further result in a hospital admission, which are disproportionately higher than the overall pediatric population. 10,11,13,15 Beyond common clinical reasons that prompt ED visits among pediatric patients with cancer, previous work has documented differences in ED utilization and disposition outcomes across socioeconomically diverse pediatric patients with cancer.…”

“…10,11,13,15 In addition, about half of ED visits among these patients further result in a hospital admission, which are disproportionately higher than the overall pediatric population. 10,11,13,15 Beyond common clinical reasons that prompt ED visits among pediatric patients with cancer, previous work has documented differences in ED utilization and disposition outcomes across socioeconomically diverse pediatric patients with cancer. 11,[14][15][16][17] In particular, lack of health insurance coverage and residence in lower income areas have been associated with lower odds of hospital admission through the ED among pediatric patients with cancer .…”

“…10,11,13,15 Beyond common clinical reasons that prompt ED visits among pediatric patients with cancer, previous work has documented differences in ED utilization and disposition outcomes across socioeconomically diverse pediatric patients with cancer. 11,[14][15][16][17] In particular, lack of health insurance coverage and residence in lower income areas have been associated with lower odds of hospital admission through the ED among pediatric patients with cancer . 11,17 These findings indicate that socioeconomically vulnerable pediatric patients with cancer are not exempt from well-documented disparities in health outcomes.…”