Emergency department visits among people with cancer: Frequency, symptoms, and characteristics

Gallaway, M. Shayne; Idaikkadar, Nimi; Tai, Eric; Momin, Behnoosh; Rohan, Elizabeth A.; Townsend, Julie S.; Puckett, Mary; Stewart, Sherri L.

doi:10.1002/emp2.12438

Cited by 41 publications

(58 citation statements)

References 33 publications

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“…All the other studies only report data on patients requiring more than one ER visit, with percentages ranging from 2 to 30% [11,17]. Although GPs can manage most symptoms at home, these hospital and ER admissions could be for treatment of difficult to manage symptoms, such as drainage for symptomatic ascites, intensified pain management or symptomatic treatment of bowel obstruction [18]. Such hospital visits should not necessarily be considered harmful to patients, but could be part of good collaboration between hospital specialists and the GP [19].…”

Section: Discussionmentioning

confidence: 99%

End-of-life care for patients with advanced ovarian cancer in the Netherlands: A retrospective registry-based analysis.

Broekman

Nijman

et al. 2022

JCO

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e17612 Background: Patients with advanced ovarian cancer have a poor prognosis and can experience debilitating abdominal symptoms in the last phase of life. Several analyses, mainly performed in the United States (US), show high rates of chemotherapy administration, and emergency room and hospital visits near the end-of-life in this patient category. No large European studies are available, while the organisation of palliative care differs between the US and Europe and between European countries. We aimed to analyse the intensity of inpatient care near the end-of-life in the Netherlands and perform a cross-study comparison with previous reports. Methods: All patients with ovarian cancer that died in 2016 and 2017 were identified from the database of the foundation Dutch Hospital Data (DHD). For the last six months of life the following parameters of aggressive care were extracted: administration of chemotherapy, emergency room (ER) visits, surgical procedures, hospital and intensive care unit (ICU) admissions. Data were analysed for the cohort as a whole and separately for three age categories: < 60, 60-75 and > 75 years of age. The intensity of inpatient care was compared to previously reported European and US data. Results: A total of 2172 patients died with ovarian cancer in 2016 and 2017 in the Netherlands. Data on medical care use was available for 1775 patients. During the last 6 months of life, chemotherapy was given to half of the ovarian cancer patients and the same percentage of patients was admitted to hospital. Chemotherapy administration near the end-of-life was infrequent, with only 12% of patients receiving chemotherapy in the last month of life. Surgery and ICU admissions in the final 6 months of life were rare (< 10%). Our cohort showed the lowest percentages of all five indicators of aggressive care reported thus far. The use of chemotherapy in the six months prior to death was highest in patients 60-75 years of age compared to younger or older patients. ER visits and hospital admissions were less frequent in patients > 75 years of age compared to the younger age groups. Conclusions: Aggressive medical care use in the final 6 months of life in this Dutch cohort of ovarian cancer patients was lower than in other previously reported cohorts.

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Section: Discussionmentioning

confidence: 99%

End-of-life care for patients with advanced ovarian cancer in the Netherlands: A retrospective registry-based analysis.

Broekman

Nijman

et al. 2022

JCO

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“…Studies have shown that cancer patients are more likely to visit an ED for acute care when compared to the general population [11]. Due to the increasing frequency of patients with cancer presenting to the ED for acute complications of their primary cancer or cancer treatment regimen, emergency physicians should acknowledge their vital role in the care of patients with cancer.…”

Section: Implications For Education and Training In Emmentioning

confidence: 99%

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

et al. 2022

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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.

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“… 2 5 6 Left unmanaged, these symptoms can negatively impact patient quality of life 6 7 and functional ability, 8 and contribute to potentially avoidable emergency department visits and hospitalizations. 9–11 …”

Section: Introductionmentioning

confidence: 99%

“…Across the cancer continuum, patients may experience multiple, concurrent symptoms, including pain, fatigue, nausea, vomiting, anxiety, depression and more 2 5 6. Left unmanaged, these symptoms can negatively impact patient quality of life6 7 and functional ability,8 and contribute to potentially avoidable emergency department visits and hospitalizations 9–11…”

Section: Introductionmentioning

confidence: 99%

Implementation strategies to address barriers to evidence-informed symptom management among outpatient oncology nurses: a scoping review protocol

et al. 2022

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IntroductionDespite the availability of clinical practice guidelines for cancer symptom management, cancer care providers do not consistently use them in practice. Oncology nurses in outpatient settings are well positioned to use established guidelines to inform symptom assessment and management; however, issues concerning inconsistent implementation persist. This scoping review aims to (1) identify reported barriers and facilitators influencing symptom management guideline adoption, implementation and sustainability among specialised and advanced oncology nurses in cancer-specific outpatient settings and (2) identify and describe the components of strategies that have been used to enhance the implementation of symptom management guidelines.Methods and analysisThis scoping review will follow Joanna Briggs Institute methodology. Electronic databases CINAHL, Embase, Emcare and MEDLINE(R) and grey literature sources will be searched for studies published in English from January 2000 to March 2022. Primary studies and grey literature reports of any design that include specialised or advanced oncology nurses practicing in cancer-specific outpatient settings will be eligible. Sources describing factors influencing the adoption, implementation and sustainability of cancer symptom management guidelines and/or strategies to enhance guideline implementation will be included. Two reviewers will independently screen for eligibility and extract data. Data extraction of factors influencing implementation will be guided by the Consolidated Framework for Implementation Research (CFIR), and the seven dimensions of implementation strategies (ie, actors, actions, targets, temporality, dose, justifications and outcomes) will be used to extract implementation strategy components. Factors influencing implementation will be analysed descriptively, synthesised according to CFIR constructs and linked to the Expert Recommendations for Implementating Change strategies. Results will be presented through tabular/diagrammatic formats and narrative summary.Ethics and disseminationEthics approval is not required for this scoping review. Planned knowledge translation activities include a national conference presentation, peer-reviewed publication, academic social media channels and dissemination within local oncology nursing and patient networks.

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Emergency department visits among people with cancer: Frequency, symptoms, and characteristics

Cited by 41 publications

References 33 publications

End-of-life care for patients with advanced ovarian cancer in the Netherlands: A retrospective registry-based analysis.

End-of-life care for patients with advanced ovarian cancer in the Netherlands: A retrospective registry-based analysis.

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

Implementation strategies to address barriers to evidence-informed symptom management among outpatient oncology nurses: a scoping review protocol

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