Research
What Brings Cancer Patients to the Emergency Room?
Pain, nausea, and shortness of breath are the most common reasons that cancer patients seek emergency treatment, according to a nationwide analysis including the Rochester area and patients from the Wilmot Cancer Institute.
The study is believed to be the first prospective, multicenter effort to describe emergency department use by individuals with active cancer, of which there are an estimated 15 million people in the country.
“We are seeing patients with active cancer every single day in our emergency department and most cancer centers with attached emergency departments are experiencing the exact same thing,” said David Adler, M.D., M.P.H., who led the study for the University of Rochester Medical Center. He is a professor of trauma and Public Health Sciences, and works at Strong Hospital.
The analysis was reported by JAMA Network Open, an online medical journal. Researchers were able to detect patterns and details about patient conditions, in real time, and use the information to formulate goals for improvements, the authors wrote.
The study involved 1,075 patients at 18 emergency departments associated with cancer centers in the U.S., including 70 people seen in the Emergency Department at Strong Memorial Hospital. The majority had received cancer treatment in the preceding 30 days and more than half had advanced or metastatic disease.
Pain was a problem in 62 percent of the patients. Poorly controlled pain was common during the week before the emergency department visit, the study found.
Surprisingly, Adler noted, only 8 percent of patients with active cancer had been engaged with palliative care services, which is focused on preventing and treating pain and other symptoms, and improving quality of life.
In addition, more than half of the patients across the U.S. who came to emergency departments had not signed an advanced directive. This is a document stating the patient’s expressed wishes about medical care if he or she cannot communicate.
“This is a system failure,” Adler said. “Whether the issue lies with primary care doctors or oncologists, or others — the problem is that when a cancer patient gets to the emergency department it may be too late to see this through.”
Another key finding: two-thirds of the patients were admitted to the hospital from the emergency department, but 25 percent of them stayed less than two days — suggesting an opportunity for better outpatient management, Adler said.
“One reason that emergency physicians may choose to admit cancer patients is to guarantee that the patient connects with a specialist or an oncologist as soon as possible,” he said. “If you discharge a patient, it allows for risk of inadequate follow-up, especially if the person lives in a rural or underserved area.”
Goal-oriented collaborations among oncologists, palliative care, and emergency physicians are needed, the study concluded.
In a further analysis of the same data, Adler and URMC colleague Beau Abar, Ph.D., associate professor of trauma, confirmed the validity of a triage tool widely used by emergency departments for patients with active cancer.
The Ohio State University Wexner Medical Center led the larger national study; Adler not only led the local research but played a key role in writing the manuscript for JAMA. The physicians and researchers who participated are part of the Comprehensive Oncologic Emergencies Research Network (CONCERN), which is supported by the National Cancer Institute.
The Ohio State University Wexner Medical Center led the larger national study; Adler not only led the local research but played a key role in writing the manuscript for JAMA. The physicians and researchers who participated are part of the Comprehensive Oncologic Emergencies Research Network (CONCERN), which is supported by the National Cancer Institute.
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