Emergency visits among end-of-life cancer patients in Taiwan: a nationwide population-based study

Abstract

BackgroundAn increased number of emergency visits at the end of life may indicate poor-quality cancer care. The study aimed to investigate the prevalence and utilization of emergency visits and to explore the reasons for emergency department (ED) visits among cancer patients at the end of life.MethodsA retrospective cohort study was performed by tracking one year of ambulatory medical service records before death. Data were collected from the cancer dataset of Taiwan’s National Health Insurance Research Database (NHIRD).ResultsA total of 32,772 (19.2%) patients with malignant cancer visited EDs, and 23,883 patients died during the study period. Of these, the prevalence of emergency visits in the mortality group was 81.5%, and their ED utilization was significantly increased monthly to the end of life. The most frequent types of cancer were digestive and peritoneum cancers (34.8%), followed by breast cancer (17.7%) and head and neck cancers (13.3%). Older patients, males, and those diagnosed with metastases, respiratory or digestive cancer were more likely to use ED services at the end of life. Use of an ED service in the nearest community hospital to replace medical centers for dying cancer patients would be more acceptable in emergency situations.ConclusionsOur study provided population-based evidence related to ED utilization. An understanding of the reasons for such visits could be useful in preventing overuse of ED visits to improve the quality of end-of-life care.

Factors driving frequent attendance at emergency departments for patients with head and neck cancer

“…In this study, we found that these factors associated with an increased risk of FA status: lower SES (housing subsidy type) and greater comorbidity. This was similar to the findings from other studies …”

“…Studies have shown FAs to have a higher chronic disease burden, lower SES, and higher utilization of nonemergency health care services . In a previous national cohort study, we found that certain cancer profiles increased the risk of ED FA: head and neck cancers were up to twice as likely to be an FA …”

“…Previous studies have evaluated the risk factors for increased health care utilization . The commonest ED complaints of patients with cancer appear to be similar to that of the general population but may also present with unique cancer‐related issues, either from the cancer itself or from complications of treatment or side effects . In our study, we explore the presenting complaints or diagnoses for patients with head and neck cancer presenting to ED and compare the diagnosis profile by FA vs non‐FA, and by individual risk factors for FA.…”

Cancer patients as frequent attenders in emergency departments: A national cohort study

“…We included patients that had recently undergone curative oncologic treatment, rather than limiting the analyses to end‐of‐life patients. Furthermore, given the cohort size and diversity of diagnoses, we were able to divide the malignancies by specific diagnoses rather than collective groups such as “all gastrointestinal” cancers . This could account for the positive correlation between a diagnosis of esophageal, stomach, liver, pancreatic or biliary cancer and FA, as each of these was analyzed independently of neutral‐risk gastrointestinal cancers, such as colorectal cancer patients, which account for the largest group of gastrointestinal cancers in most populations.…”

“…Nevertheless, many cancer patients attend ED for issues unique to their diagnoses, stage, or treatment. Hence, several studies have focused on certain subgroups, such as end‐of‐life patients, and patients suffering from complications or side effects of chemotherapy, surgery, or radiotherapy …”