Cancer pain management in the emergency department: a multicenter prospective observational trial of the Comprehensive Oncologic Emergencies Research Network (CONCERN)

Coyne, Christopher J.; Reyes‐Gibby, Cielito C.; Durham, Danielle D.; Abar, Beau; Adler, David; Bastani, Aveh; Bernstein, Steven L.; Baugh, Christopher W.; Bischof, Jason J.; Grudzen, Corita; Henning, Daniel J.; Hudson, Matthew F.; Klotz, Adam; Lyman, Gary H.; Madsen, Troy; Pallin, Daniel J.; Rico, Juan Felipe; Ryan, Richard J.; Shapiro, Nathan I.; Swor, Robert A.; Thomas, Charles R.; Venkat, Arvind; Wilson, Jason; Yeung, Sai Ching Jim; Caterino, Jeffrey M.

doi:10.1007/s00520-021-05987-3

Cited by 23 publications

(32 citation statements)

References 41 publications

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“…34 Adequately addressing pain will lead to not only decreased mortality but also decreased risk of 30-day hospital readmission and increased patient satisfaction. 33 Patients admitted to the hospital from the EDOU had more consultation requests during their observation stay than did those who were discharged, likely because of the complexity of their medical problems. This highlights that these patients were sicker, requiring further hospital care.…”

Section: Discussionmentioning

confidence: 99%

“…However, management of cancer-related pain continues to be challenging for ED clinicians, and many patients leave with continued pain. 33 For this reason, the EDOU should be considered for patients with cancer whose pain complaints are not fully addressed in the ED. Pain management is one of the most common reasons for EDOU placement, not only in our cohort but also as previously reported.…”

Section: Discussionmentioning

confidence: 99%

“… 34 Adequately addressing pain will lead to not only decreased mortality but also decreased risk of 30-day hospital readmission and increased patient satisfaction. 33 …”

Section: Discussionmentioning

confidence: 99%

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Outcomes of Patients Placed in an Emergency Department Observation Unit of a Comprehensive Cancer Center

Chaftari

Lipe

Wattana

et al. 2022

JCO Oncology Practice

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PURPOSE Emergency department observation units (EDOUs) have been shown to decrease length of stay and improve cost effectiveness. Yet, compared with noncancer patients, patients with cancer are placed in EDOUs less often. In this study, we aimed to describe patients who were placed in a cancer center's EDOU to discern their clinical characteristics and outcomes. METHODS We performed a retrospective observational study that included all patients age 18 years and older who presented to our emergency department (ED) and were placed in the EDOU between March 1, 2019, and February 29, 2020. The patients' electronic medical records were queried for demographics, comorbidities, diagnosis at the time of placement in the EDOU, length of stay, disposition from the EDOU, ED return within 72 hours after discharge from the EDOU, and mortality outcomes at 14 and 30 days. RESULTS A total of 2,461 visits were eligible for analysis. Cancer-related pain was the main reason for observation in more than one quarter of the visits. The median length of stay in the EDOU was approximately 23 hours, and 69.6% of the patients were discharged. The ED return rate for unscheduled visits at 72 hours was 1.9%. The 14- and 30-day mortality rates were significantly higher for patients who were admitted than for those who were discharged (14 days: 1.7% v 0.3%, P < .001; 30 days: 5.9% v 1.8%, P < .001). CONCLUSION Our data suggest that placing patients with cancer in EDOUs is safe, reduces admissions, and reserves hospital resources for patients who can receive the most benefit without compromising care.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Outcomes of Patients Placed in an Emergency Department Observation Unit of a Comprehensive Cancer Center

Chaftari

Lipe

Wattana

et al. 2022

JCO Oncology Practice

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“…Pain is common in patients with cancer 1 seeking emergency department (ED) care 2 . Fifty percent of ED patients with cancer present with pain and 39% report pain at final ED pain assessment 3 . Thus, ED practitioners seemingly remain challenged to manage pain in this population.…”

Section: Total Nhw Nhb P‐valuementioning

confidence: 99%

“…Patients were asked to report the presence and intensity of pain at ED presentation and at ED disposition on a 10-point numeric rating scale. Report of any pain in the ED was categorized as none (0), mild (1)(2)(3)(4), moderate (5)(6), or severe (7)(8)(9)(10). For home pain medication use, patients were queried on pain medication use and type in the 14 days prior to ED visit study.…”

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confidence: 99%

Examining pain among non‐Hispanic Black and non‐Hispanic White patients with cancer visiting emergency departments: CONCERN (Comprehensive Oncologic Emergencies Research Network)

Hudson

Strassels

Durham

et al. 2021

Academic Emergency Medicine

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Pain is common in patients with cancer 1 seeking emergency department (ED) care. 2 Fifty percent of ED patients with cancer present with pain and 39% report pain at final ED pain assessment. 3 Thus, ED practitioners seemingly remain challenged to manage pain in this population. Such findings support calls encouraging safe, effective, and timely pain management in EDs. 4 Brown and colleagues 5 encourage research into any racial or socioeconomic gaps in the treatment of pain in ED cancer patients. The purpose of this prospective cohort study was to assess the presence of pain management disparities in this cohort of ED cancer patients stratified by race. This is a secondary analysis of prospectively collected data from The Comprehensive Oncologic Emergencies Research Network (CONCERN), a National Cancer Institute (NCI)sponsored multicenter research consortium. CONCERN conducted a multicenter prospective cohort study of 18 EDs from March 1, 2016, through January 30, 2017. The parent study methods and population have been previously described. 6 Briefly, study participants were adults aged ≥18 years with active cancer who presented to the ED. Active cancer was defined as (1) ongoing (or within 12 months) antineoplastic therapy (radiotherapy, chemotherapy, cancer-related surgery, or other); (2) previously identified or ED physician-identified cancer recurrence or metastasis; or (3) cancer-related symptoms. Participants were excluded for the following reasons: pregnancy, incarceration, a psychiatric chief complaint, primary evaluation as a trauma response, non-English speaking, previous enrollment, or too ill or otherwise unable to participate in survey administration. Due to limited numbers of Hispanic participants, this study does not provide specific analyses of ethnicity. The study's null hypothesis was that there is no difference between non-Hispanic Black (NHB) and non-Hispanic White (NHW) in pain reports or treatment. Each site received institutional review board approval. All participants provided written informed consent; no incentive was provided. The study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guidelines.

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Benefits of Spiritual and Religious Support in the Pain Management of Cancer Patients: A Literature Scoping Review

Cavalcanti

Costa²,

Soares³

et al. 2022

J Relig Health

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Cancer pain management in the emergency department: a multicenter prospective observational trial of the Comprehensive Oncologic Emergencies Research Network (CONCERN)

Cited by 23 publications

References 41 publications

Outcomes of Patients Placed in an Emergency Department Observation Unit of a Comprehensive Cancer Center

Outcomes of Patients Placed in an Emergency Department Observation Unit of a Comprehensive Cancer Center

Examining pain among non‐Hispanic Black and non‐Hispanic White patients with cancer visiting emergency departments: CONCERN (Comprehensive Oncologic Emergencies Research Network)

Benefits of Spiritual and Religious Support in the Pain Management of Cancer Patients: A Literature Scoping Review

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