Attributes of cancer patients admitted to the emergency department in one year

Abstract

BACKGROUND: Cancer patients frequently visit the emergency department (ED) with various symptoms of cancer. The purpose of this study was to determine the clinical characteristics and 1-year survival rate of cancer patients in the ED of a university hospital. METHODS:We conducted a retrospective review of 408 cancer patients who visited the ED between January 2011 and December 2011. Patient information on demographics, chief complaints, fi ndings, and survival was gathered from the hospital registry and corresponding health administration. RESULTS:The study included 240 (58.8%) males and 168 (41.2%) females with a median age of 57.9 years (range 19-87). Regarding cancer staging, 266 patients (65.3%) had metastatic disease and 142 (34.7%) had local and loco-regional disease. The hospitalization rate was 59.6%. The most common symptoms were shortness of breath (23.2%), pain (17.8%), fever (14.2%), and nausea/vomiting (14.4%). The most common cancer sites were the lung (32.5%), gastrointestinal system (25.4%), and breast (9.3%). The initial evaluation determined progressive disease (42.4%), chemotherapy effects (20.7%), infections (17.2%), radiotherapy effects (4.7%), extravasation (1.8%), anemia (1.4%), and unknown (11.3%). During follow up, 191 (46.8%) patients died after admission to the ED. The 1-year overall survival of all patients was 7.3 months.CONCLUSIONS: Symptom management in cancer patients is a complex multifaceted concern for the emergency physician. Because of the increasing prevalence of cancer patients, emergency physicians should develop consensus algorithms in collaboration with the relevant disciplines to manage the commonly encountered problems.

Perfil Dos Pacientes Oncológicos Atendidos Em Uma Unidade De Emergência

“…Algumas emergências oncológicas tem início súbito ou podem demorar meses a desenvolver e manifestam-se abruptamente, ao passo que outras se manifestam em algumas horas, resultando em complicações e agravamentos da doença, podendo levar a morte (3,4). São nos serviços de urgência e emergên-cias que aparecem os pacientes com as patologias de maior incidência na população, sendo elas emergências clínicas ou cirúrgi-cas, envolvendo os politraumatismos, as doenças cardiovasculares e cerebrovasculares e as doenças oncológicas que hoje são a segunda maior causa de morte (superadas apenas pelas doenças do aparelho circulatório e pelas causas externas / violência).…”

“…São nos serviços de urgência e emergên-cias que aparecem os pacientes com as patologias de maior incidência na população, sendo elas emergências clínicas ou cirúrgi-cas, envolvendo os politraumatismos, as doenças cardiovasculares e cerebrovasculares e as doenças oncológicas que hoje são a segunda maior causa de morte (superadas apenas pelas doenças do aparelho circulatório e pelas causas externas / violência). Estima-se que em bem pouco tempo o câncer já seja a principal causa de morte no mundo se medidas preventivas não forem instaladas efetivamente na população (3,4).…”

“…A maioria das emergências oncológicas podem ser categorizados como metabóli-ca (hipercalcemia, síndrome de inadequado hormona anti-diurética, síndroma de lise tumoral), hematológica (neutropenia febril), estrutural (medula espinhal, compressão de nervos periféricos, derrame pericárdico maligno) ou efeitos colaterais de agentes quimioterápicos (diarréia, extravasamento) (3,4).…”

“…Portanto, serviços de emergência desempenham um papel importante no atendimento para este grupo de pacientes (3,4).…”

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

“…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.…”