Emergency department visits for symptoms experienced by oncology patients: a systematic review

Vandyk, Amanda; Harrison, Margaret B.; Macartney, Gail; Ross‐White, Amanda; Stacey, Dawn

doi:10.1007/s00520-012-1459-y

Cited by 197 publications

(162 citation statements)

References 37 publications

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“…A previous study [9] found that pain, respiratory distress, and fever were the most common symptoms in ED visits, and our results were consistent with this fi nding. The high prevalence of lung and gastrointestinal cancers among the study population may explain this; 54.7% of the patients admitted to the ED with shortness of breath were diagnosed with lung cancer.…”

Section: Discussionsupporting

confidence: 93%

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

Muallaoğlu

Karagün

Mertsoylu

et al. 2014

World Journal of Emergency Medicine

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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.

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Section: Discussionsupporting

confidence: 93%

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

Muallaoğlu

Karagün

Mertsoylu

et al. 2014

World Journal of Emergency Medicine

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“…2 In systematic review of 18 studies examining emergency department (ED) visits among oncology patients, more than half of ED visits resulted in hospital admissions. 9 However, reports of toxicities experienced by oncology patients were inadequate to synthesize data across studies, highlighting the need for consistent use of patient-reported toxicity measures. 9 Furthermore, regular assessment of toxicities among oncology patients can predict ED visits.…”

Section: Introductionmentioning

confidence: 99%

“…9 However, reports of toxicities experienced by oncology patients were inadequate to synthesize data across studies, highlighting the need for consistent use of patient-reported toxicity measures. 9 Furthermore, regular assessment of toxicities among oncology patients can predict ED visits. In a cohort study of more than 45,000 oncology patients in Canada, the patient-reported Edmonton Symptom Assessment Scale was used to predict subsequent ED visits within 7 days of assessment.…”

Section: Introductionmentioning

confidence: 99%

Toxicity-Related Factors Associated With Use of Services Among Community Oncology Patients

Harrison

Stella

LaVasseur

et al. 2016

JOP

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QUESTION ASKED: What are the frequency and correlates of unplanned health care service use related to chemotherapy toxicities among patients receiving first-cycle chemotherapy at five community-based ambulatory oncology practices?SUMMARY ANSWER: Unplanned service use resulting from toxicity-related factors was reported by more than one-third of patients in this community oncology population, and 45% of patients reported at least one severe or disabling toxicity. Pain and nausea were most often rated severe or disabling (by 18% and 15% of patients, respectively) and were the top reasons for service use.WHAT WE DID: In this prospective survey study, newly diagnosed patients with breast, lung, head and neck, or colorectal cancer or non-Hodgkin lymphoma completed a questionnaire that measured unplanned service use and overall distress, plus severity of nausea, vomiting, diarrhea, constipation, mouth sores, intravenous catheter problems, pain, fever and chills, extremity edema, and dyspnea on a 5-point scale (1, did not experience; 5, disabling).WHAT WE FOUND: Among 106 patients (white, 98%; female, 74.5%; mean age 6 standard deviation, 60 6 11), frequently reported toxicities were pain, nausea, diarrhea, and constipation, and 36 patients (34%) reported unplanned service use: 29% reported oncologist visits, 14% reported emergency department visits, and 8% reported hospitalizations. In regression, factors significantly associated with unplanned service use were high patient-reported distress and receipt of colonystimulating factor, a proxy measure for intensity of the chemotherapy regimen. BIAS, CONFOUNDING FACTOR(S), DRAWBACKS:Limitations included recruitment of a convenience sample, exclusion of patients with previous cancer diagnoses, a predominantly white, non-Hispanic sample, and imbalanced participant sexes. The survey instrument did not detect source of pain. Survey responses may have been subject to recall bias. REAL-LIFE IMPLICATIONS:Our study addressed several issues critical to optimal delivery of patient care in community oncology settings, including the feasibility of toxicity reporting in a community oncology population and the relationship between toxicities and unplanned health care service use. With a 91% participation rate among eligible patients and a 100% survey completion rate among patients consenting to participate, this study demonstrated that brief patient surveys are a feasible method for systematic assessment of patient-reported toxicities and associated unplanned service use. Although severe toxicities warrant medical attention, routine use of symptom assessment tools can inform proactive symptom management approaches to reduce toxicity burden between scheduled visits. With further study of the most significant toxicities in a larger, more diverse sample of patients, strategies can be developed for implementation of clinical practice guidelines to improve management of toxicities in community oncology practices (Fig). Abstract PurposeCommunity oncology practices frequently manage chemoth...

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“…7 Pain is the most frequent symptom to prompt unscheduled medical care in oncology patients. [8][9][10] Cancer charities in the UK have raised concerns about pain management in the OOH period. 11,12 OOH primary care in the UK is accessed via centralised telephone systems, and provided by healthcare practitioners from a variety of professional backgrounds.…”

Section: Introductionmentioning

confidence: 99%

Utilising out-of-hours primary care for assistance with cancer pain: a semi-structured interview study of patient and caregiver experiences

et al. 2015

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BackgroundPain is the most frequent complication of cancer and an important reason for out-ofhours (OOH) primary care contacts by patients with established cancer. Existing quantitative data give little insight into the reason for these contacts. Exploring such encounters of care could highlight ways to improve anticipatory cancer care and communication between daytime and OOH primary care services. AimTo explore the experiences, views, and opinions of patients and their caregivers who have used OOH primary care for help with managing cancer pain. Design and settingA semi-structured interview study with patients and caregivers who have utilised an OOH primary care service in Grampian, Scotland, because of pain related to cancer. MethodSemi-structured interviews with 11 patients and four caregivers (n = 15), transcribed verbatim and analysed using framework analysis and, to a lesser extent, inductive thematic analysis. ResultsSix key themes emerged: making sense of pain and predicting its likely course; beliefs about analgesics; priority daytime access; the importance of continuity of care and communication between all involved; barriers and facilitators to seeking help in the OOH period; and satisfaction/dissatisfaction with OOH care. Three prominent sub-themes were: patient knowledge; the influence of a caregiver on decision-making; and the benefits of having a palliative care summary. ConclusionEffective daytime and anticipatory care can positively influence OOH care. Interventions that aid patients in understanding cancer pain, communicating about pain, utilising analgesics effectively, and seeking appropriate and timely help may improve cancer pain management.

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Emergency department visits for symptoms experienced by oncology patients: a systematic review

Abstract: Individuals with cancer present to emergency departments with a myriad of symptoms. Over half of emergency department visits resulted in hospital admissions. Few symptoms were defined adequately to compare data across studies, thereby revealing an important gap in cancer symptom reporting.

Cited by 197 publications

References 37 publications

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

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

Toxicity-Related Factors Associated With Use of Services Among Community Oncology Patients

Utilising out-of-hours primary care for assistance with cancer pain: a semi-structured interview study of patient and caregiver experiences

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