Trends in Adult Cancer–Related Emergency Department Utilization

Rivera, Donna R.; Gallicchio, Lisa; Brown, Jeremy; Liu, Benmei; Kyriacou, Demetrios N.; Shelburne, Nonniekaye

doi:10.1001/jamaoncol.2017.2450

Cited by 170 publications

(148 citation statements)

References 10 publications

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“…Patients with cancer account for more than 4.5 million US emergency department (ED) visits annually. 1 , 2 This estimate, derived from ED diagnostic codes, likely underestimates the true annual incidence of cancer-related ED visits among the 15.5 million US residents with cancer. 3 Approximately two-thirds of ED visits by patients with cancer result in hospital admission, 4 , 5 affirming the ED as a critical portal addressing acute illness issues and the continuum of cancer management.…”

Section: Introductionmentioning

confidence: 99%

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Analysis of Diagnoses, Symptoms, Medications, and Admissions Among Patients With Cancer Presenting to Emergency Departments

et al. 2019

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Key Points Question What are the characteristics of patients with active cancer presenting to US emergency departments? Findings In this multicenter cohort study of 1075 adult patients with active cancer in the Comprehensive Oncologic Emergencies Research Network (CONCERN), patients commonly presented with symptoms such as pain (62.1%) and nausea (31.3%), were frequently treated for potential infection (26.5%), and were admitted (57.2%; 25.0% for <2 days) or placed in observation (7.6%). Meaning Opportunities for improving emergency department care for patients with cancer include establishing protocols and processes for prompt and appropriate symptom control, creating improved risk stratification tools, and improving outpatient management to prevent ED visits.

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Section: Introductionmentioning

confidence: 99%

“… 7 Symptom-driven issues are the most common complaints in patients with cancer visiting EDs, including pain and respiratory and gastrointestinal tract issues. 2 , 4 However, a knowledge gap exists for providing optimal cancer care in the ED. 8 …”

Section: Introductionmentioning

confidence: 99%

Analysis of Diagnoses, Symptoms, Medications, and Admissions Among Patients With Cancer Presenting to Emergency Departments

et al. 2019

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“…Defining cancer‐specific risk factors for FA would be critical in the identification of patients with unmet needs. This could present opportunities for improving the quality of cancer care, both in the ED itself, as well as in the community, with the ultimate goal of reducing the need for ED visits . Therefore, the primary objective of this study was to identify risk factors for FA by cancer patients using a national database of all patients treated in public sector hospitals.…”

Section: Introductionmentioning

confidence: 99%

“…1,2 A recent study of ED utilization by cancer patients showed that the commonest ED diagnoses were similar to those of the general population (pneumonia, chest pain, and urinary tract infection). 2 Nevertheless, many cancer patients attend ED for issues unique to their diagnoses, stage, or treatment. Hence, several studies have focused on certain subgroups, such as end-of-life patients, [3][4][5][6][7][8] and patients suffering from complications or side effects of chemotherapy, surgery, or radiotherapy.…”

Section: Introductionmentioning

confidence: 99%

“…This could present opportunities for improving the quality of cancer care, both in the ED itself, 21 as well as in the community, with the ultimate goal of reducing the need for ED visits. 2 Therefore, the primary objective of this study was to identify risk factors for FA by cancer patients using a national database of all patients treated in public sector hospitals. The secondary objective was to examine the trajectory of FA patients after they became FA, including their subsequent survival, and time to repeat FA.…”

Section: Introductionmentioning

confidence: 99%

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Cancer patients as frequent attenders in emergency departments: A national cohort study

et al. 2018

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BackgroundCancer patients contribute significantly to emergency department (ED) utilization. The objective of this study was to identify factors associated with patients becoming ED frequent attenders (FA) after a cancer‐related hospitalization.MethodsA retrospective cohort study was conducted using national administrative, billing, and death records of Singapore residents discharged alive from Singapore public hospitals from January 2012 to December 2015, with a primary discharge diagnosis of cancer. Patients with four or more ED visits within any 12‐month period after discharge from their index hospitalization were classified as FA. Time to FA distribution was estimated using the Kaplan‐Meier method, and factors associated with risk of FA were identified using multivariate Cox regression analyses.ResultsRecords for 47 235 patients were analyzed, of whom 2980 patients were FA within the study period. Age (<17 years, hazard ratio [HR] 2.92, 95% CI 2.28‐3.74; 75‐84 years, HR 1.29, 95% CI 1.16‐1.45; and ≥85 years, HR 1.71, 95% CI 1.45‐2.02, relative to age 55‐64), male gender (HR 1.26, 95% CI 1.16‐1.37), Charlson comorbidity index (HR 1.21, 95% CI 1.19‐1.23), and socioeconomic factors (Medifund use, HR 1.40, 95% CI 1.23‐1.59; housing subsidy type, HR 2.12, 95% CI 1.77‐2.54) were associated with increased risk of FA. Primary malignancies associated with FA included brain and spine (HR 2.51, 95% CI 1.67‐3.75), head and neck cancers (tongue, HR 2.05, 95% CI 1.27‐3.31; hypopharynx, HR 2.72, 95% CI 1.56‐4.74), lung (trachea and lung, HR 1.57, 95% CI 1.13‐2.18; pleural, HR 3.69, 95% CI 2.12‐6.34), upper gastrointestinal (stomach, HR 1.93, 95% CI 1.26‐2.74; esophagus, HR 4.13, 95% CI 2.78‐6.13), hepato‐pancreato‐biliary (liver, HR 1.42, 95% CI 1.01‐2.00, pancreas, HR 2.48, 95% CI 1.72‐3.59), and certain hematological malignancies (diffuse non‐Hodgkin's lymphoma, HR1.59, 95% CI 1.08‐2.33, lymphoid leukemia, HR 1.86, 95% CI 1.21‐2.86). Brain (HR 1.69, 95% CI 1.27‐2.26), lung (HR 1.31, 95% CI 1.01‐1.71), liver (HR 1.46, 95% CI 1.14‐1.89), and bone (HR 1.35, 95% CI 1.04‐1.76) metastases were also associated with FA.ConclusionThere are cancer‐specific factors contributing to ED frequent attendance. Additional resources should be allocated to support high‐risk groups and prevent unnecessary ED use.

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Trends and Characteristics of Potentially Preventable Emergency Department Visits Among Patients With Cancer in the US

et al. 2023

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ImportanceAn initial step to reducing emergency department (ED) visits among patients with cancer is to identify the characteristics of patients visiting the ED and examine which of those visits could be prevented.ObjectiveTo explore nationwide trends and characteristics of ED visits and examine factors associated with potentially preventable ED visits and unplanned hospitalizations among patients with cancer in the US.Design, Setting, and ParticipantsThis cross-sectional study used data on ED visits from the National Hospital Ambulatory Medical Care Survey from January 1, 2012, to December 31, 2019; US Cancer Statistics reports were used to estimate new cancer cases each year. Frequencies and trends among 35 510 014 ED visits by adult patients (aged ≥18 years) with cancer were calculated.Main Outcomes and MeasuresThe primary outcome was potentially preventable ED visits, and secondary outcomes were unplanned hospitalizations and the immediacy of the ED visits. Potentially preventable ED visits were identified using the Centers for Medicare &amp; Medicaid Services definition. The Emergency Severity Index, a triage algorithm that ranks patients based on the urgency of their health care condition, was used to measure the immediacy of ED visits (immediate [most urgent], emergent, urgent, less urgent, and nonurgent), with the categories of immediate and emergent classified as high acuity. The Wilcoxon rank sum test was used to calculate trends in ED visits among patients with cancer over time. Multivariable logistic regression analyses were performed to examine the associations of patient, hospital, and temporal factors with potentially preventable ED use and ED use resulting in hospitalization.ResultsAmong 854 911 106 ED visits, 35 510 014 (4.2%) were made by patients with cancer (mean [SD] age, 66.2 [16.2] years); of those, 55.2% of visits were among women, 73.2% were among non-Hispanic White individuals, 89.8% were among patients living in a private residence, and 54.3% were among Medicare enrollees. A total of 18 316 373 ED visits (51.6%) were identified as potentially preventable, and 5 770 571 visits (21.3%) were classified as high acuity. From 2012 to 2019, potentially preventable ED visits increased from 1 851 692 to 3 214 276. Pain (36.9%) was the most common reason for potentially preventable ED visits. The number of patients who visited an ED because of pain increased from 1 192 197 in 2012 to 2 405 849 in 2019 (a 101.8% increase). Overall, 28.9% of ED visits resulted in unplanned hospitalizations, which did not change significantly over time (from 32.2% in 2012 to 26.6% in 2019; P = .78 for trend). Factors such as residence in a nursing home (odds ratio, 1.73; 95% CI, 1.25-2.41) were positively associated with having a potentially preventable ED visit, and factors such as the presence of more than 1 comorbidity (odds ratio, 1.82; 95% CI, 1.43-2.32) were positively associated with having an unplanned hospitalization.Conclusions and RelevanceIn this study, 51.6% of ED visits among patients with cancer were identified as potentially preventable, and the absolute number of potentially preventable ED visits increased substantially between 2012 and 2019. These findings highlight the need for cancer care programs to implement evidence-based interventions to better manage cancer treatment complications, such as uncontrolled pain, in outpatient and ambulatory settings.

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Trends in Adult Cancer–Related Emergency Department Utilization

Cited by 170 publications

References 10 publications

Analysis of Diagnoses, Symptoms, Medications, and Admissions Among Patients With Cancer Presenting to Emergency Departments

Analysis of Diagnoses, Symptoms, Medications, and Admissions Among Patients With Cancer Presenting to Emergency Departments

Cancer patients as frequent attenders in emergency departments: A national cohort study

Trends and Characteristics of Potentially Preventable Emergency Department Visits Among Patients With Cancer in the US

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