Recognizing the emergency department’s role in oncologic care: a review of the literature on unplanned acute care

Lash, Rebecca; Hong, Arthur S.; Bell, Janice F.; Reed, Sarah C.; Pettit, Nicholas

doi:10.1186/s44201-022-00007-4

Cited by 27 publications

(32 citation statements)

References 73 publications

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“…Consistent with previous studies, we found that nationwide each year, 4.2% of all ED visits were made by patients with cancer. This rate was similar to the rate of ED visits reported for other conditions, such as congestive heart failure (4.0%), chronic kidney disease (3.5%), and cerebrovascular disease (3.7%) . We also found that between 2012 and 2019, the number of cancer-related ED visits increased by 67.1% compared with cancer incidence, which only increased by 7.5% .…”

Section: Discussionsupporting

confidence: 85%

“…This rate was similar to the rate of ED visits reported for other conditions, such as congestive heart failure (4.0%), chronic kidney disease (3.5%), and cerebrovascular disease (3.7%). 45 We also found that between 2012 and 2019, the number of cancer-related ED visits increased by 67.1% compared with cancer incidence, which only increased by 7.5%. 46,47 The disproportionate increase in the number of ED visits by patients with cancer has put a substantial burden on EDs that are already operating at peak capacity.…”

Section: Discussionsupporting

confidence: 57%

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Trends and Characteristics of Potentially Preventable Emergency Department Visits Among Patients With Cancer in the US

et al. 2023

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ImportanceAn initial step to reducing emergency department (ED) visits among patients with cancer is to identify the characteristics of patients visiting the ED and examine which of those visits could be prevented.ObjectiveTo explore nationwide trends and characteristics of ED visits and examine factors associated with potentially preventable ED visits and unplanned hospitalizations among patients with cancer in the US.Design, Setting, and ParticipantsThis cross-sectional study used data on ED visits from the National Hospital Ambulatory Medical Care Survey from January 1, 2012, to December 31, 2019; US Cancer Statistics reports were used to estimate new cancer cases each year. Frequencies and trends among 35 510 014 ED visits by adult patients (aged ≥18 years) with cancer were calculated.Main Outcomes and MeasuresThe primary outcome was potentially preventable ED visits, and secondary outcomes were unplanned hospitalizations and the immediacy of the ED visits. Potentially preventable ED visits were identified using the Centers for Medicare &amp; Medicaid Services definition. The Emergency Severity Index, a triage algorithm that ranks patients based on the urgency of their health care condition, was used to measure the immediacy of ED visits (immediate [most urgent], emergent, urgent, less urgent, and nonurgent), with the categories of immediate and emergent classified as high acuity. The Wilcoxon rank sum test was used to calculate trends in ED visits among patients with cancer over time. Multivariable logistic regression analyses were performed to examine the associations of patient, hospital, and temporal factors with potentially preventable ED use and ED use resulting in hospitalization.ResultsAmong 854 911 106 ED visits, 35 510 014 (4.2%) were made by patients with cancer (mean [SD] age, 66.2 [16.2] years); of those, 55.2% of visits were among women, 73.2% were among non-Hispanic White individuals, 89.8% were among patients living in a private residence, and 54.3% were among Medicare enrollees. A total of 18 316 373 ED visits (51.6%) were identified as potentially preventable, and 5 770 571 visits (21.3%) were classified as high acuity. From 2012 to 2019, potentially preventable ED visits increased from 1 851 692 to 3 214 276. Pain (36.9%) was the most common reason for potentially preventable ED visits. The number of patients who visited an ED because of pain increased from 1 192 197 in 2012 to 2 405 849 in 2019 (a 101.8% increase). Overall, 28.9% of ED visits resulted in unplanned hospitalizations, which did not change significantly over time (from 32.2% in 2012 to 26.6% in 2019; P = .78 for trend). Factors such as residence in a nursing home (odds ratio, 1.73; 95% CI, 1.25-2.41) were positively associated with having a potentially preventable ED visit, and factors such as the presence of more than 1 comorbidity (odds ratio, 1.82; 95% CI, 1.43-2.32) were positively associated with having an unplanned hospitalization.Conclusions and RelevanceIn this study, 51.6% of ED visits among patients with cancer were identified as potentially preventable, and the absolute number of potentially preventable ED visits increased substantially between 2012 and 2019. These findings highlight the need for cancer care programs to implement evidence-based interventions to better manage cancer treatment complications, such as uncontrolled pain, in outpatient and ambulatory settings.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionsupporting

confidence: 57%

Trends and Characteristics of Potentially Preventable Emergency Department Visits Among Patients With Cancer in the US

et al. 2023

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“…Describing post‐cancer diagnosis ED utilization has been studied, and anywhere from 2% to 4% of all ED visits are attributable toward persons with a diagnosis of cancer 20 . As cancer survival rates increase, the number of cancer‐related ED visits also increases, and future work is needed to improve cancer management in the ED and potentially reduce unnecessary ED visits 20,21 . Prior ED use among patients with cancer is the strongest independent predictor for future ED use after a new diagnosis 22 .…”

Section: Discussionmentioning

confidence: 99%

“… 20 As cancer survival rates increase, the number of cancer‐related ED visits also increases, and future work is needed to improve cancer management in the ED and potentially reduce unnecessary ED visits. 20 , 21 Prior ED use among patients with cancer is the strongest independent predictor for future ED use after a new diagnosis. 22 Since ICD‐coded cancer diagnoses require tissue sample and biopsy, little to no confirmed cancer diagnoses originate from an ED visit.…”

Section: Discussionmentioning

confidence: 99%

Worsened outcomes of newly diagnosed cancer in patients with recent emergency care visits: A retrospective cohort study of 3699 adults in a safety net health system

Pettit

Stewart

et al. 2022

Cancer Medicine

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Introduction: Many patients receive a suspected diagnosis of cancer through an emergency department (ED) visit. Time to treatment for a new diagnosis of cancer is directly associated with improved outcomes with little no describing the ED utilization prior to the diagnosis of cancer. We hypothesize that patients that have an ED visit in proximity to a diagnosis of cancer will have worse outcomes, including mortality.Methods: This study is a retrospective cohort study of all patients with cancer diagnosed at Eskenazi Health (Indiana) between 2016 and 2019. Individual health characteristics, ED utilization, cancer types, and mortality were studied. We compared those patients seen in the ED within 6 months prior to their diagnosis (cases) to patients not seen in the ED (controls).Results: A total of 3699 patients with cancer were included, with 1239 cases (33.50%). Patients of black race had higher frequencies in the cases vs. controls (46.57% vs. 40.68%). Lung cancer was the most frequently observed cancer among cases vs. controls (11.70% vs. 5.57%). For the cases, 232 patients were deceased (18.72%) compared with 247 patients among the controls (10.04%, p < 0.0001, OR 2.06 95% confidence interval [CI] 1. 70-2.51). An ED visit in past 6 months (OR = 1.73, 95% CI 1.38-2.18) and Medicaid insurance type (versus commercial, OR = 4.16, 95% CI 2.45-7.07) were associated with of mortality. Female gender (OR = 0.76, 95% CI 0.67-0.88), tobacco use (OR = 1.62, 95% CI 138-1.90), and Medicaid insurance type (versus commercial, OR = 2.56, 95% CI 2.07-3.47) were associated with prior ED use. Conclusions:Over one third of patients with cancer were seen in the ED within 6 months prior to their cancer diagnosis. Higher mortality rates were observed for those seen in the ED. Future studies are needed to investigate the association and impact that the ED has on eventual cancer diagnoses and outcomes.

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“…Projections estimate that the number of new cases in both sexes between 65 and 85 years old will raise from 9.95 million in 2020 to 17.7 million in 2040 8 . Approximately 4% of all adult ED visits in the US are for cancer-related complaints 9 .…”

Section: Epidemiology and Characterization Of Older Adults With Cance...mentioning

confidence: 99%

Geriatric emergencies in older adults with cancer: why older patients need a special approach

Torres¹,

García-Valdés²,

Henriquez-Santos³

2023

GAMO

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The number of older adults with cancer presenting to the emergency departments for evaluation and treatment is increasing. There is an essential need to identify and better understand the effects of cancer and treatment on health outcomes for older adults with cancer. Cancer-related emergencies can manifest as geriatric syndromes in this population. Falls, delirium, and acute pain are highly prevalent, multifactorial, and associated with substantial morbidity and poor outcomes. In the present article, we review existing evidence regarding common geriatric emergencies in older adults with cancer, as well as the importance of a special approach and management in this population.

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Recognizing the emergency department’s role in oncologic care: a review of the literature on unplanned acute care

Cited by 27 publications

References 73 publications

Trends and Characteristics of Potentially Preventable Emergency Department Visits Among Patients With Cancer in the US

Trends and Characteristics of Potentially Preventable Emergency Department Visits Among Patients With Cancer in the US

Worsened outcomes of newly diagnosed cancer in patients with recent emergency care visits: A retrospective cohort study of 3699 adults in a safety net health system

Geriatric emergencies in older adults with cancer: why older patients need a special approach

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