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

Fleshner, Lauren; Lagree, Andrew; Shiner, Audrey; Alera, Marie Angeli; Bielecki, M; Grant, Robert C.; Kiss, Alex; Krzyzanowska, Monika K.; Cheng, Ivy; Tran, William T.; Gandhi, Sonal

doi:10.1093/oncolo/oyad161

Cited by 3 publications

(6 citation statements)

References 63 publications

(191 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Por lo tanto, puede representar una útil herramienta de ayuda a la hora de predecir la existencia de BV en los pacientes con neoplasias sólidas (con/sin neutropenia), uno de los grupos más vulnerables y con una frecuente presentación clínica inespecífica [ 3 , 4 , 13 ], para así optimizar las decisiones más importantes e inmediatas que se deben tomar en los SUH: indicación de extracción de HC, administrar una terapia antimicrobiana adecuada y precoz y el ingreso hospitalario o el alta domiciliaria, entre otras [ 1 , 13 , 14 ].…”

Section: Discussionunclassified

“…Aunque la técnica de extracción de los HC está bien protocolizada [ 16 ], todavía existen controversias en relación a cuándo debemos obtenerlos en el SUH [ 1 , 8 , 13 ]. A pesar de ello, es una práctica creciente en la valoración inicial de los pacientes con cáncer y sospecha de infección en el SUH [ 1 - 3 , 5 ]. En estos, la sospecha de bacteriemia tiene un importante significado diagnóstico y pronóstico.…”

Section: Discussionunclassified

“…Nuestro estudio presenta algunas limitaciones: la indicación de solicitar HC se realiza según las decisiones del médico responsable, los casos fueron incluidos por oportunidad(cuando los investigadores estuvieron de guardia) o la tasa de HC contaminados (4,9%), aunque menor que en estudios realizados en nuestro medio, sí es superior a la recomendada (< 3%) [ 5 , 6 , 15 , 16 ]. No obstante, creemos que los resultados representan un fiel reflejo de la realidad de nuestros SUH donde la incidencia de pacientes con neoplasia sólida y neutropenia es muy importante cuantitativa y cualitativamente [ 1 - 3 ].…”

Section: Discussionunclassified

“…En este escenario, entre el 1-3% de los pacientes que se atienden en los SUH lo hacen con el diagnóstico de una neoplasia sólida y, se conoce, que estas cifras también aumentan cada año [3,4]. Los pacientes con cáncer tienen hasta cuatro veces más probabilidades de presentar sepsis y bacteriemia en los SUH y la mortalidad a los 30 días de estos enfermos con bacteriemia verdadera (BV) confirmada desde el SUH supone el doble o el triple que el resto de pacientes con cáncer pero sin BV [1,[3][4][5][6].…”

Section: Pacientes Y Métodosunclassified

“…Por todo ello, la sospecha y confirmación de BV tiene un relevante significado diagnóstico, pronóstico y obliga a cambiar algunas de las decisiones a tomar en el SUH (alta o ingreso, extraer HC y administrar el antimicrobiano adecuado y precoz). Además, en el paciente con neoplasia sólida éstas adquieren una especial relevancia, ya que las manifestaciones clínicas son a menudo inespecíficas y variables, lo que dificulta su sospecha precoz y conlleva al fallo en el diagnóstico, en la solicitud de pruebas complementarias y, habitualmente, la administración de antimicrobianos no necesarios o su retraso en los casos donde sí son necesarios[ 1 , 3 , 8 ]. Así, en los últimos años se ha convertido en el objetivo de muchos autores elaborar modelos predictivos de BV identificables en los SUH que incluyen variables clínicas, epidemiológicas y analíticas [ 9 , 10 ].…”

Section: Introductionunclassified

See 4 more Smart Citations

Usefulness of the MPB-INFURG-SEMES model to predict bacteremia in the patient with solid tumor in the Emergency Department

Muelas González,

Torner Marchesi,

Peláez Díaz

et al. 2024

Rev Esp Quimioter

View full text Add to dashboard Cite

Objective. To analyse a new risk score to predict bacteremia (MPB-INFURG-SEMES) in the patients with solid tumor attender for infection in the emergency departments (ED). Patients and methods. Prospective, multicenter observational cohort study of blood cultures (BC) obtained from adult patients with solid neoplasia treated in 63 EDs for infection from November 1, 2019, to March 31, 2020. The predictive ability of the model was analyzed with the area under the Receiver Operating Characteristic curve (AUC-ROC). The prognostic performance for true bacteremia was calculated with the chosen cut-off for getting the sensitivity, specificity, positive predictive value and negative predictive value. Results. A total of 857 blood samples wered cultured. True cases of bacteremia were confirmed in 196 (22.9%). The remaining 661 cultures (77.1%) wered negative. And, 42 (4.9%) were judged to be contaminated. The model’s area under the receiver operating characteristic curve was 0.923 (95% CI,0.896-0.950). The prognostic performance with a model’s cut-off value of ≥ 5 points achieved 95.74% (95% CI, 94,92-96.56) sensitivity, 76.06% (95% CI, 75.24-76.88) specificity, 53.42%(95% CI, 52.60-54.24) positive predictive value and 98.48% (95% CI, 97.66- 99.30) negative predictive value. Conclusion. The MPB-INFURG-SEMES score is useful for predicting bacteremia in the adults patients with solid tumor seen in the ED.

show abstract

Section: Discussionunclassified

Section: Pacientes Y Métodosunclassified

Section: Introductionunclassified

See 3 more Smart Citations

Usefulness of the MPB-INFURG-SEMES model to predict bacteremia in the patient with solid tumor in the Emergency Department

Muelas González,

Torner Marchesi,

Peláez Díaz

et al. 2024

Rev Esp Quimioter

View full text Add to dashboard Cite

show abstract

Survivorship in Advanced Lung Cancer: Understanding a New Landscape and Opportunities

Presley,

Dalal,

Davenport

et al. 2024

Am Soc Clin Oncol Educ Book

View full text Add to dashboard Cite

People with advanced lung cancer represent a distinct group whose needs remain understudied, especially compared with people diagnosed with limited-stage disease. Fortunately, novel treatments such as tyrosine kinase inhibitors and immune checkpoint inhibitors are leading to significant advances in prognosis and survival, even among those with advanced disease at the time of diagnosis. However, there are known gaps in symptom management, psychosocial and nutritional support, complex care coordination, health behavior coaching, and health care delivery efforts among patients living with advanced lung cancer. Many of these patients would benefit from survivorship and palliative care approaches. In particular, survivorship care may include health care maintenance, treatment of immune-related adverse events and late- or long-term effects, frailty assessment and rehabilitation, and care coordination. Palliative care may be best suited to discuss ongoing symptom management, advanced care planning, and end-of-life considerations, as well as psychosocial well-being. To this end, we share a review of the current status of the palliative and survivorship care infrastructure for patients with advanced lung cancer and provide suggestions across the care continuum for this diverse group of patients and families.

show abstract

A Comprehensive Evaluation of Emergency Department Utilization by Patients With Cirrhosis

Parvataneni,

Sarkis,

Haugh

et al. 2024

Am J Gastroenterol

View full text Add to dashboard Cite

BACKGROUND: Emergency Department (ED) based care is required for cirrhosis management, yet the burden of cirrhosis-related ED healthcare utilization (HCU) is understudied. We aimed to describe ED utilization within a statewide health system and compare the outcomes of high ED use (HEDU) versus non-HEDU in individuals with cirrhosis. METHODS: We retrospectively reviewed charts of adults with cirrhosis who presented to any of 16 EDs within the Indiana University Health system in 2021. Patient characteristics, features of the initial ED visit, subsequent 90-day healthcare use, and 360-day outcomes were collected. Multivariable logistic regression models were used to identify predictors HEDU status which was defined as ≥2 ED visits within 90 days after the index ED visit. RESULTS: There were 2124 eligible patients (mean age 61.3 years, 53% male, and 91% White). Major etiologies of cirrhosis were alcohol (38%), MASH (27%), and viral hepatitis (21%). Cirrhosis was newly diagnosed in the ED visit for 18.4%. Most common reasons for ED visits were abdominal pain (21%), shortness of breath (19%), and ascites/volume overload (16%). Of the initial ED visits 20% (n=424) were potentially avoidable. The overall 90-day mortality was 16%. Within 90 days, there were 366 HEDU (20%). Notable variables independently associated with HEDU were MELD-Na (aOR=1.044, 95% CI 1.005-1.085), prior ED encounter (aOR=1.520, 95% CI 1.136-2.034), and avoidable initial ED visit (aOR=1.938, 95% CI 1.014-3.703). Conclusions: Abdominal pain, shortness of breath, and ascites/fluid overload are the common presenting reasons for ED visits for patients with cirrhosis. Patients with cirrhosis presenting to the ED experience a 90-day mortality rate of 16%, and among those who initially visited the ED, 20% were HEDU. We identified several variables independently associated with HEDU. Our observations pave the way for developing interventions to optimize the care of patients with cirrhosis presenting to the ED and to lower repeated ED visits.

show abstract

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

Cited by 3 publications

References 63 publications

Usefulness of the MPB-INFURG-SEMES model to predict bacteremia in the patient with solid tumor in the Emergency Department

Usefulness of the MPB-INFURG-SEMES model to predict bacteremia in the patient with solid tumor in the Emergency Department

Survivorship in Advanced Lung Cancer: Understanding a New Landscape and Opportunities

A Comprehensive Evaluation of Emergency Department Utilization by Patients With Cirrhosis

Contact Info

Product

Resources

About