The current state of acute oncology training for emergency physicians: a narrative review

Abstract

Patients with cancer represent a growing population of patients seeking acute care in emergency departments (ED) nationwide. Emergency physicians are expected to provide excellent, consistent care to all ED patients; however, emergency medicine (EM) education and training of acute oncology is lacking.To explore this topic, the Society for Academic Emergency Medicine Oncologic Emergencies Interest Group recruited experts in the field to provide a narrative description of the current state of EM education relating to acute oncology. This review of expert opinions explores the current state of acute oncology education in EM and identifies key content gaps that merit early investment.Current emergency physician training and knowledge relating to acute oncology likely reflects the American Board of Emergency Medicine Model of Clinical Practice. Key topics such as immunotherapy are absent from the most recent revision of the Model of Clinical Practice and consequently represent a knowledge gap for large numbers of emergency physicians. Additionally, there is limited penetration of guideline-based care for symptom management in the ED setting. As such, additional attention should be provided to training programs and research efforts to address these knowledge gaps.In conclusion, the current state of acute oncology education and training of emergency physicians is lacking and merits significant investment to assure the ability of emergency physicians to provide superior care for the growing population of patients with cancer.

Current gaps in emergency medicine core content education for oncologic emergencies: A targeted needs assessment

“…5,6 This approach to curriculum design includes the following steps: (1) identification and analysis of a general need or problem, (2) targeted needs assessment of a group of learners and their environment, (3) development of curricular goals and objectives, (4) selection of curriculum content and education strategies, (5) implementation of the educational intervention, and (6) evaluation and feedback of the individual learners and program. 7 Step 1, identifying the need for an oncologic EM curriculum, has been completed and a key issue cited in these papers was the persistence of a knowledge gap despite coverage of core oncologic EM topics during residency training that may be exacerbated due to a lag between the rapid advancements in oncology and integration of that knowledge into EM education and standards of care 3,4 Following Step 2 of Kern's curriculum design, this study obtained a targeted needs assessment through a survey of EM residents, EM attending physicians, and oncologists consisting of medical oncologists and oncologic surgeons to determine specific knowledge gaps to address within an oncologic EM curriculum.…”

Drivers of Emergency Department Use Among Oncology Patients in the Era of Novel Cancer Therapeutics: A Systematic Review

“…This may be reflective of the lack of recognition with these agents in the ED. 72 It is also plausible that novel treatments have not been used long enough to influence publication patterns; additionally, many patients still receive cytotoxic chemotherapy (sometimes alongside targeted treatment), and it may be difficult to establish the relative impact of either therapy on ED visits. In fact, one study found that less than 10% of oncology visits could be attributed to immunotherapy adverse events, including pain, dyspnea, and pneumonia.…”

Diagnosis of cancer in the Emergency Department: A scoping review

“…It is also unclear if system or care enhancements could improve the care or outcomes of cancer patients identified in the ED. 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 .…”

“…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 , 51 , 52 , 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 , 55 , 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.…”