Cancer complaints: The profile of patients from the emergency department of a Brazilian oncology teaching hospital

Abstract

Background: With the increase in prevalence of cancer in our society, we aim to clarify through primary data use what drives emergency department (ED) utilization among patients with cancer. Methods: This is a cross-sectional study. A direct survey was applied to cancer patients over 277 visits in 2015. Variables including chief complaint for current and last visit, frequency of visits, primary tumor site, and demographics were collected. Results: Pain was the most common complaint, responsible for 40% of visits, followed by constitutional symptoms (17%), and gastrointestinal complaints (11%). Abdominal pain was the single most noted pain type, with 18.4%, and had the highest rate of recurrence. It was followed by back pain, dyspnea, asthenia and fever, accounting for 8.5%, 8.5%, 8.1% and 7%, respectively. Cervical cancer represented 14.8% of patients, followed by breast (11.6%) and lung (7.6%) cancers. The majority of patients visited the emergency department less than once a month. Conclusion: The drivers of emergency department utilization among patients with cancer found through primary use data mostly confirm findings from larger studies with secondary use data. Our research underscores the burden of pain to patients with cancer, as it is the most common complaint leading to ED visits, and generally requires multiple visits. Abdominal pain was more likely to recur than other complaints. Patients could benefit from focused outpatient pain management, and from more research and education targeting cancer-related pain.

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

“…A range of international studies describes a similar ecology of reasons for ED visits. Similar to the US, studies from Brazil, Australia, the UK, Canada, and Taiwan identify the most common complaints to be abdominal pain, back pain, dyspnea, weakness/fatigue, infection, fever (neutropenic and non-neutropenic), nausea/vomiting, drug reaction, surgical site issues, shortness of breath, and process of care issues [76,78,81,82].…”

Mechanisms of cancer pain

“…The need to modify current pain management protocols in patients with cancer is indicated by reports that pain is the most common complaint leading to emergency unit visits by patients with cancer ( 17 – 19 ). Despite well-established findings demonstrating that the experience of pain can impact long-term clinical outcomes, patients with cancer frequently receive insufficient pain management ( 20 ).…”

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

“…Thirty-three studies evaluated patient-level factors and 8 factors were significant ( Table 3 ). 7 , 11 , 14 , 29-33 , 35-37 , 41 , 44-47 , 49-59 , 61 , 62 , 64-66 , 68 Up to 53.6% of patients with cancer who visit the ED were aged 65-74 years and up to 89% of patients were married. 11 , 29 , 35 , 41 , 49 , 60 Employed patients constituted 55.6% of ED users, and 45.3% of patients reported sufficient income.…”

“… 7 , 14 , 29 , 30 , 32 , 33 , 35 , 41 , 47 , 52 , 56 , 59-62 , 64-66 , 68 Most visits occur during working hours, with up to 86.4% of arrivals during the week, up to 66% before midnight, and up to 71.1% between 7:00 AM and 6:59 PM. 7 , 29 , 41 , 59 , 62 , 69 Most patients present with a severity index of “potentially unstable” (40.0-50.0%) or “stable-urgent” (up to 51.4%). 29 , 33 , 68 …”