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Watson CH, Alhanti B, Zhao C, Havrilesky LJ, Davidson BA. Development of a Predictive Model for Emergency Department Utilization and Unanticipated Hospital Admission in Patients Receiving Cancer Treatment for Solid Tumor Malignancies. JCO Oncol Pract 2024:OP2300571. [PMID: 39303173 DOI: 10.1200/op.23.00571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 04/26/2024] [Accepted: 07/01/2024] [Indexed: 09/22/2024] Open
Abstract
PURPOSE Unanticipated health care resource utilization, in the form of either emergency department utilization (EDU) or hospital admission (HA), may be an indicator of lower-quality cancer care. The objective of this study was to develop a predictive model for EDU and HAs within 14 days of receipt of systemic therapy for patients with solid tumors. METHODS We abstracted electronic health data on oncology encounters from all patients receiving systemic therapy for solid tumors from March 1, 2015, to August 21, 2020, in the Duke University Health System. We defined a primary composite outcome of an EDU or HA within 14 days after the encounter and then developed a predictive model for the primary outcome using least absolute shrinkage and selection operator regression. To evaluate the model, we calculated the area under the receiver operator curve and the calibration slope. RESULTS Twelve thousand eight hundred ninety unique patients with 134,641 oncology encounters were included. Five thousand one hundred fifty of these patients (40.0%) had at least one EDU or HA within 14 days of at least one treatment. Forty-six variables were incorporated into the final model. The top predictors, in order of absolute value of the predictive coefficients, were temperature, systolic blood pressure, cancer group, and marital status. The model's AUC was 0.73 (95% CI, 0.722 to 0.732), indicating good sensitivity and specificity to outcome. CONCLUSION The model developed in this study demonstrated good sensitivity in identifying patients with solid tumors who are at highest risk for EDU or HA and could be implemented in clinical practice to allow for preventive outpatient interventions.
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Affiliation(s)
- Catherine H Watson
- Division of Gynecologic Oncology, Vanderbilt University School of Medicine, Nashville, TN
| | | | - Congwen Zhao
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC
| | - Laura J Havrilesky
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Duke Cancer Institute, Duke University School of Medicine, Durham, NC
| | - Brittany A Davidson
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Duke Cancer Institute, Duke University School of Medicine, Durham, NC
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Khalil M, Woldesenbet S, Iyer S, Rashid Z, Altaf A, Katayama E, Chatzipanagiotou OP, Carpenter KM, Pawlik TM. Impact of Spousal Mental Illness on Healthcare Utilization Among Patients With Gastrointestinal Cancer. J Surg Oncol 2024. [PMID: 39233565 DOI: 10.1002/jso.27860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2024] [Accepted: 08/08/2024] [Indexed: 09/06/2024]
Abstract
BACKGROUND Informal caregiving involves increased responsibilities, with financial and emotional challenges, thereby affecting the well-being of the caregiver. We aimed to investigate the effect of spousal mental illness on hospital visits and medical spending among patients with gastrointestinal (GI) cancer. METHODS Patients who underwent GI cancer surgery between 2013 and 2020 were identified from the IBM Marketscan database. Multivariable regression analysis was used to examine the association between spousal mental illness and healthcare utilization. RESULTS A total of 6,035 patients underwent GI surgery for a malignant indication. Median age was 54 years (IQR: 49-59), most patients were male (n = 3592, 59.5%), and had a CCI score of ≤ 2 (n = 5512, 91.3%). Of note, in the 1 year follow-up period, 19.4% (anxiety: n = 509, 8.4%; depression: n = 301, 5.0%; both anxiety and depression: n = 273, 4.5%; severe mental illness: n = 86, 1.4%) of spouses developed a mental illness. On multivariable analysis, after controlling for competing factors, spousal mental illness remained independently associated with increased odds of emergency department visits (OR 1.20, 95% CI 1.05-1.38) and becoming a super healthcare utilizer (OR 1.37, 95% CI 1.04-1.79), as well as 12.1% (95% CI 10.6-15.3) higher medical spending. CONCLUSION Among patients with GI cancer spousal mental illness is associated with higher rates of outpatient visits, emergency department visits, and expenditures during the 1-year postoperative period. These findings underscore the importance of caregiving resources and counseling in alleviating caregiver burden, thereby reducing the overall burden on the healthcare system.
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Affiliation(s)
- Mujtaba Khalil
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Selamawit Woldesenbet
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Sidharth Iyer
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Zayed Rashid
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Abdullah Altaf
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Erryk Katayama
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Odysseas P Chatzipanagiotou
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Kristen M Carpenter
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, Ohio, USA
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
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MiriMoghaddam M, Bohlouli B, Lai H, Ganatra S, Amin M. Healthcare Utilization of Oral and Oropharyngeal Cancer Patients in Emergency Department and Outpatient Settings: An 8-year Population-Based Study. Head Neck 2024; 46:1439-1449. [PMID: 38558155 DOI: 10.1002/hed.27753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 03/05/2024] [Accepted: 03/14/2024] [Indexed: 04/04/2024] Open
Abstract
INTRODUCTION This study aimed to determine trends in the healthcare utilization by Oral Cavity and Oropharyngeal cancer patients across emergency department (ED) and outpatient settings in Alberta and examine the predictors of ED visits. METHODS This is a retrospective, population-based, cohort study using administrative data collected by all healthcare facilities between 2010 and 2019 in Alberta, Canada. Trend of visits to different facilities, patients' primary diagnosis, and predictors of ED visits were analyzed. RESULTS In total, 34% of patients had at least one cancer-related ED visit. With a rise of 31% in cancer incidence, there was a notable upswing in visits to outpatient clinics and community offices, while ED visits decreased. Cancer stage, rural residence, high material deprivation score, and treatments were found as predictors of ED visits. CONCLUSION Improved symptom management and better care access for disadvantaged and rural oral cancer patients may decrease avoidable ED visits.
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Affiliation(s)
- Masoud MiriMoghaddam
- Faculty of Medicine and Dentistry, School of Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Babak Bohlouli
- Faculty of Medicine and Dentistry, School of Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Hollis Lai
- Faculty of Medicine and Dentistry, School of Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Seema Ganatra
- Faculty of Medicine and Dentistry, School of Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Maryam Amin
- Faculty of Medicine and Dentistry, School of Dentistry, University of Alberta, Edmonton, Alberta, Canada
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Wernli KJ, Haupt EC, Chawla N, Osuji T, Shen E, Smitherman AB, Casperson M, Kirchhoff AC, Zebrack BJ, Keegan THM, Kushi L, Baggett C, Kaddas HK, Ruddy KJ, Sauder CAM, Wun T, Figueroa Gray M, Chubak J, Nichols H, Hahn EE. Emergency Department Use in Adolescent and Young Adult Cancer Early Survivors from 2006 to 2020. J Adolesc Young Adult Oncol 2024. [PMID: 38682323 DOI: 10.1089/jayao.2023.0174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2024] Open
Abstract
Purpose: Understanding emergency department (ED) use in adolescent and young adult (AYA) survivors could identify gaps in AYA survivorship. Methods: We conducted a cohort study of 7925 AYA survivors (aged 15-39 years at diagnosis) who were 2-5 years from diagnosis in 2006-2020 at Kaiser Permanente Southern California. We calculated ED utilization rates overall and by indication of the encounter (headache, cardiac issues, and suicide attempts). We estimated rate changes by survivorship year and patient factors associated with ED visit using a Poisson model. Results: Cohort was 65.4% women, 45.8% Hispanic, with mean age at diagnosis at 31.3 years. Overall, 38% of AYA survivors had ≥1 ED visit (95th percentile: 5 ED visits). Unadjusted ED rates declined from 374.2/1000 person-years (PY) in Y2 to 327.2 in Y5 (p change < 0.001). Unadjusted rates declined for headache, cardiac issues, and suicide attempts. Factors associated with increased ED use included: age 20-24 at diagnosis [relative risk (RR) = 1.30, 95% CI 1.09-1.56 vs. 35-39 years]; female (RR = 1.27, 95% CI 1.11-1.47 vs. male); non-Hispanic Black race/ethnicity (RR 1.64, 95% CI 1.38-1.95 vs. non-Hispanic white); comorbidity (RR = 1.34, 95% CI 1.16-1.55 for 1 and RR 1.80, 95% CI 1.40-2.30 for 2+ vs. none); and public insurance (RR = 1.99, 95% CI 1.70-2.32 vs. private). Compared with thyroid cancer, cancers associated with increased ED use were breast (RR = 1.45, 95% CI 1.24-1.70), cervical (RR = 2.18, 95% CI 1.76-2.71), colorectal (RR = 2.34, 95% CI 1.94-2.81), and sarcoma (RR = 1.39, 95% CI 1.03-1.88). Conclusion: ED utilization declined as time from diagnosis elapsed, but higher utilization was associated with social determinants of health and cancer types.
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Affiliation(s)
- Karen J Wernli
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, USA
| | - Eric C Haupt
- Kaiser Permanente Southern California, Pasadena, California, USA
| | - Neetu Chawla
- Veteran's Affairs Los Angeles County, Los Angeles, California, USA
| | - Thearis Osuji
- Kaiser Permanente Southern California, Pasadena, California, USA
| | - Ernest Shen
- Kaiser Permanente Southern California, Pasadena, California, USA
| | - Andrew B Smitherman
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | | | - Anne C Kirchhoff
- Department of Pediatrics, Huntsman Cancer Institute and the University of Utah, Salt Lake City, Utah, USA
| | - Bradley J Zebrack
- School of Social Work, University of Michigan, Ann Arbor, Michigan, USA
| | - Theresa H M Keegan
- Center for Oncology Hematology Outcomes Research and Training (COHORT), Division of Hematology and Oncology, University of California Davis Comprehensive Cancer Center, Sacramento, California, USA
| | - Lawrence Kushi
- Division of Research, Kaiser Permanente, Northern California, Oakland, California, USA
| | - Christopher Baggett
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Heydon K Kaddas
- Department of Pediatrics, Huntsman Cancer Institute and the University of Utah, Salt Lake City, Utah, USA
| | - Kathryn J Ruddy
- Division of Medical Oncology, Department of Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Candice A M Sauder
- Division of Surgical Oncology, Department of Surgery, University of California, Davis Medical Center, Sacramento, California, USA
| | - Theodore Wun
- Center for Oncology Hematology Outcomes Research and Training (COHORT), Division of Hematology and Oncology, University of California Davis Comprehensive Cancer Center, Sacramento, California, USA
| | | | - Jessica Chubak
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - Hazel Nichols
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Erin E Hahn
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, USA
- Kaiser Permanente Southern California, Pasadena, California, USA
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Lin D, Tan R, Teigland C, Hernandez S, Kim S, Kilgore KM. Race/ethnicity and socioeconomic position in emergency department utilization in patients with hepatocellular carcinoma. Future Oncol 2024:1-13. [PMID: 38639552 DOI: 10.2217/fon-2023-0412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 03/01/2024] [Indexed: 04/20/2024] Open
Abstract
Aim: Evaluate the association of race/ethnicity and socioeconomic position (SEP) on emergency department (ED) visits for patients with hepatocellular carcinoma (HCC), which may reflect access to and quality of cancer care. Materials & methods: Patients with HCC identified from a commercial multi-payer claims database between 2015 and 2018 were matched to near-neighborhood social determinants of health (SDOH) and stratified by race/ethnicity and SEP (proxied by annual household income). Analyses evaluated the effect of race/ethnicity and SEP on ED utilization, adjusting for SDOH, demographic and clinical characteristics using multivariable regression methods. Results: A total of 22,247 patients were included. Black and Hispanic patients had 43 and 18% higher ED utilization than White patients at higher-income levels (p < 0.01); these differences were nonsignificant at lower-income. Regardless of income level, Asian patients had lower ED utilization. Conclusion: Further research on the intersectionality between race/ethnicity, SEP and other SDOH may guide structural-level interventions to address health inequities.
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Affiliation(s)
- Daniel Lin
- Department of Medical Oncology, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA
| | - Ruoding Tan
- Public Affairs and Access, Genentech, Inc., South San Francisco, CA 94080, USA
| | - Christie Teigland
- Research Science and Advanced Analytics, Inovalon, Inc. Bowie, MD 20716, USA
| | - Sairy Hernandez
- Public Affairs and Access, Genentech, Inc., South San Francisco, CA 94080, USA
| | - Seung Kim
- Research Science and Advanced Analytics, Inovalon, Inc. Bowie, MD 20716, USA
| | - Karl M Kilgore
- Research Science and Advanced Analytics, Inovalon, Inc. Bowie, MD 20716, USA
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Prendergast H, Stratton R, Butler N, Mannan N, Khosla S. Understanding Barriers and Distress Experienced Among Cancer Patients: Analysis from an Urban Academic Emergency Department. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2024:10.1007/s13187-024-02435-8. [PMID: 38619797 DOI: 10.1007/s13187-024-02435-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/29/2024] [Indexed: 04/16/2024]
Abstract
The purpose of this study was to examine barriers and facilitators to compliance for cancer care in patients utilizing an emergency department (ED)-based assessment. Adult ED patients who either had active cancer or a history of cancer were enrolled between August 2020 and Jan 2022 for this prospective cohort study. We piloted the National Comprehensive Cancer Network (NCCN) Distress Thermometer. Multivariable regression analyses were used to assess the predictors of high distress. Of the 152 patients enrolled, 73% were Black patients, 11% were non-Hispanic White, and 16% included patients from other racial and ethnic groups (including 10.5% Hispanic patients); 73% of the sample had active cancer. The current ED visit was cancer related for 44%. The mean score on the Distress Thermometer was 4 (SD = 2; range 0-8) with 30% having a high distress level of ≥ 6. Having an active cancer and race/ethnicity were significant predictors of high distress. Patients who had active cancer had three times (aOR = 3.01; 95% CI 1.12-8.10) higher odds of experiencing high distress in the past week compared to those who did not have active cancer, after adjusting for race/ethnicity and reason for visit. Practical problems and physical problems were the most common, with 43% (n = 66) and 40% (n = 61) of the patients reporting these problems, respectively. Despite significant progress in cancer care, cancer patients/survivors face difficulty in transitioning between care environments and end up seeking episodic care in the ED and experience a high level of distress.
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Affiliation(s)
- Heather Prendergast
- Department of Emergency Medicine, University of Illinois Chicago, 808 S. Wood St., Chicago, IL, 60612, USA
| | - Ryan Stratton
- Department of Emergency Medicine, University of Illinois Chicago, 808 S. Wood St., Chicago, IL, 60612, USA
| | - Nia Butler
- Department of Emergency Medicine, University of Illinois Chicago, 808 S. Wood St., Chicago, IL, 60612, USA
| | - Nasima Mannan
- University of Illinois Cancer Center, Chicago, IL, USA
| | - Shaveta Khosla
- Department of Emergency Medicine, University of Illinois Chicago, 808 S. Wood St., Chicago, IL, 60612, USA.
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Lee AR, Park H, Yoo A, Kim S, Sunwoo L, Yoo S. Risk Prediction of Emergency Department Visits in Patients With Lung Cancer Using Machine Learning: Retrospective Observational Study. JMIR Med Inform 2023; 11:e53058. [PMID: 38055320 PMCID: PMC10733827 DOI: 10.2196/53058] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 10/31/2023] [Accepted: 11/24/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Patients with lung cancer are among the most frequent visitors to emergency departments due to cancer-related problems, and the prognosis for those who seek emergency care is dismal. Given that patients with lung cancer frequently visit health care facilities for treatment or follow-up, the ability to predict emergency department visits based on clinical information gleaned from their routine visits would enhance hospital resource utilization and patient outcomes. OBJECTIVE This study proposed a machine learning-based prediction model to identify risk factors for emergency department visits by patients with lung cancer. METHODS This was a retrospective observational study of patients with lung cancer diagnosed at Seoul National University Bundang Hospital, a tertiary general hospital in South Korea, between January 2010 and December 2017. The primary outcome was an emergency department visit within 30 days of an outpatient visit. This study developed a machine learning-based prediction model using a common data model. In addition, the importance of features that influenced the decision-making of the model output was analyzed to identify significant clinical factors. RESULTS The model with the best performance demonstrated an area under the receiver operating characteristic curve of 0.73 in its ability to predict the attendance of patients with lung cancer in emergency departments. The frequency of recent visits to the emergency department and several laboratory test results that are typically collected during cancer treatment follow-up visits were revealed as influencing factors for the model output. CONCLUSIONS This study developed a machine learning-based risk prediction model using a common data model and identified influencing factors for emergency department visits by patients with lung cancer. The predictive model contributes to the efficiency of resource utilization and health care service quality by facilitating the identification and early intervention of high-risk patients. This study demonstrated the possibility of collaborative research among different institutions using the common data model for precision medicine in lung cancer.
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Affiliation(s)
- Ah Ra Lee
- Office of eHealth Research and Business, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Hojoon Park
- Office of eHealth Research and Business, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Aram Yoo
- Office of eHealth Research and Business, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Seok Kim
- Office of eHealth Research and Business, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Leonard Sunwoo
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Sooyoung Yoo
- Office of eHealth Research and Business, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
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Kurteva S, Tamblyn R, Meguerditchian AN. Predictors of frequent emergency department visits among hospitalized cancer patients: a comparative cohort study using integrated clinical and administrative data to improve care delivery. BMC Health Serv Res 2023; 23:887. [PMID: 37608371 PMCID: PMC10464437 DOI: 10.1186/s12913-023-09854-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 07/27/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND Frequent emergency department (FED) visits by cancer patients represent a significant burden to the health system. This study identified determinants of FED in recently hospitalized cancer patients, with a particular focus on opioid use. METHODS A prospective cohort discharged from surgical/medical units of the McGill University Health Centre was assembled. The outcome was FED use (≥ 4 ED visits) within one year of discharge. Data retrieved from the universal health insurance system was analyzed using Cox Proportional Hazards (PH) model, adopting the Lunn-McNeil approach for competing risk of death. RESULTS Of 1253 patients, 14.5% became FED users. FED use was associated with chemotherapy one-year pre-admission (adjusted hazard ratio (aHR) 2.60, 95% CI: 1.80-3.70), ≥1 ED visit in the previous year (aHR: 1.80, 95% CI 1.20-2.80), ≥15 pre-admission ambulatory visits (aHR 1.54, 95% CI 1.06-2.34), previous opioid and benzodiazepine use (aHR: 1.40, 95% CI: 1.10-1.90 and aHR: 1.70, 95% CI: 1.10-2.40), Charlson Comorbidity Index ≥ 3 (aHR: 2.0, 95% CI: 1.2-3.4), diabetes (aHR: 1.60, 95% CI: 1.10-2.20), heart disease (aHR: 1.50, 95% CI: 1.10-2.20) and lung cancer (aHR: 1.70, 95% CI: 1.10-2.40). Surgery (cardiac (aHR: 0.33, 95% CI: 0.16-0.66), gastrointestinal (aHR: 0.34, 95% CI: 0.14-0.82) and thoracic (aHR: 0.45, 95% CI: 0.30-0.67) led to a decreased risk of FED use. CONCLUSIONS Cancer patients with higher co-morbidity, frequent use of the healthcare system, and opioid use were at increased risk of FED use. High-risk patients should be flagged for preventive intervention.
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Affiliation(s)
- Siyana Kurteva
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Canada.
- Clinical and Health Informatics Research Group, McGill University, Montreal, Canada.
- Department of Science, Aetion, Inc, New York, USA.
- Clinical & Health Informatics Research Group, Department of Medicine, McGill University, 2001 McGill College Avenue, Suite 1200, H3A 1G1, Montreal, Canada.
| | - Robyn Tamblyn
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Canada
- Clinical and Health Informatics Research Group, McGill University, Montreal, Canada
- Department of Medicine, McGill University Health Center, Montreal, Canada
- McGill University Health Centre, Montreal, Canada
| | - Ari N Meguerditchian
- Clinical and Health Informatics Research Group, McGill University, Montreal, Canada
- Department of Surgery, McGill University Health Center, Montreal, Canada
- Center for Outcomes Research and Evaluation, McGill University Health Centre, Montreal, Canada
- St. Mary's Research Centre, Montreal, Canada
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Anderson W, Bera K, Smith D, Tirumani SH, Ramaiya N. Emergency department imaging utilization of cancer patients treated with bevacizumab: single-institution 8-year experience. Emerg Radiol 2023; 30:407-418. [PMID: 37129686 DOI: 10.1007/s10140-023-02136-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 04/12/2023] [Indexed: 05/03/2023]
Abstract
PURPOSE This study aims to highlight the presentations, imaging, and clinical outcomes of cancer patients presenting to the emergency department (ED) while receiving bevacizumab (Avastin) therapy. METHODS Our retrospective study was based on data from a single institution to identify cancer patients who presented acutely to the ED between 2014 and 2021 within 3 months of beginning bevacizumab who subsequently received diagnostic imaging with CT, MRI, ultrasound, and/or nuclear medicine ventilation/perfusion (VQ) scans. Data gathered included presenting symptoms grouped by body system, imaging impressions, and clinical outcomes, including hospitalization and discontinuation of bevacizumab after each ED visit. Imaging examinations and patient charts were reviewed by a team of fellowship-trained radiologists, radiology residents, and medical students. RESULTS A total of 84 patients who presented to the ED were included for analysis. This included 32 (38.1%) males and 52 (61.9%) females, with a mean age of 61.2 years and an age range of 29-91 years. Neurological symptoms were the most common presenting symptoms, followed by abdominal symptoms and respiratory symptoms. Head imaging with CT and MRI was the most common imaging ordered with 55 total examinations, followed by abdominal imaging with 37 CT abdomen/pelvis (A/P) examinations, and then CT chest imaging with 22 examinations. Imaging revealed a serious adverse drug reaction in 21 (25.0%) patients, disease progression in 19 (22.6%), and no acute imaging findings in 44 (52.4%) patients. Imaging diagnoses were significantly associated with treatment planning, with a positive determination of bevacizumab-related serious adverse reaction on imaging leading to discontinuation of bevacizumab (p = 0.001). CONCLUSION Multimodality imaging was a commonly used assessment tool for cancer patients receiving bevacizumab who presented to the ED. Imaging played a crucial role in diagnosis in these patients, especially of treatment-related serious adverse reactions and disease progression. Positive imaging findings of serious adverse reactions affected patient management including discontinuation of bevacizumab.
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Affiliation(s)
- Wyatt Anderson
- Case Western Reserve University School of Medicine, Health Education Campus, 9501 Euclid Ave, Cleveland, OH, 44106, USA
| | - Kaustav Bera
- Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, 11100 Euclid Ave, Cleveland, OH, 44106, USA.
| | - Daniel Smith
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Sree Harsha Tirumani
- Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, 11100 Euclid Ave, Cleveland, OH, 44106, USA
| | - Nikhil Ramaiya
- Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, 11100 Euclid Ave, Cleveland, OH, 44106, USA
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Alandonisi MM, Al-Malki HJ, Bahaj W, Alghanmi HA. Characteristics of Emergency Visits Among Lung Cancer Patients in Comprehensive Cancer Center and Impact of Palliative Referral. Cureus 2023; 15:e37903. [PMID: 37223145 PMCID: PMC10202681 DOI: 10.7759/cureus.37903] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2023] [Indexed: 05/25/2023] Open
Abstract
INTRODUCTION During the treatment course, cancer patients are prone to develop acute symptoms that are either treatment-related or cancer-related. Emergency services are available during the whole day to manage the acute problems of patients with chronic diseases, including cancer patients. Previous studies have shown that palliative care (PC) provided at the beginning of stage IV lung cancer diagnosis helped to reduce emergency visits and increase survival rates. METHOD A retrospective study was conducted on lung cancer patients with confirmed histopathology of non-small cell cancer and small cell lung cancer who visited the emergency department (ED) from 2019 to 2021. The demographic data, disease-related-data causes of ED visits (including disposition), number of emergency visits, and palliative referral and impact on the outcome and frequency of emergency visits were reviewed. RESULTS Of a total number of 107 patients, the majority were male (68%), the median age was 64 years old, and almost half of them were smokers (51%). More than 90% of the patients were diagnosed with non-small cell lung cancer (NSCLC), more than 90% with stage IV, and a minority underwent surgery and radiation therapy. The total number of ED visits amounted to 256, and 70% of the reasons for ED visits were respiratory problems (36.57%), pain (19.4%), and gastrointestinal (GI) causes (19%), respectively. PC referral was performed only for 36% of the participants, but it had no impact on the frequency of ED visits (p-value > 0.05). Besides, the frequency of ED visits had no impact on the outcome (p-value > 0.05), whereas PC had an impact on the live status (p-value < 0.05). CONCLUSION Our study had similar findings to another study regarding the most common reason for ED visits among lung cancer patients. Improving PC engagement for patient care would render those reasons preventable and affordable. The palliative referral improved survival among our participants but had no impact on the frequency of emergency visits, which may be due to the small number of patients and the different populations included in our research. A national study should be conducted to obtain a larger sample and to determine the impact of PC on ED visits.
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Affiliation(s)
- Munzir M Alandonisi
- Department of Medical Oncology, Oncology Center, King Abdullah Medical City, Makkah, SAU
| | - Hussain J Al-Malki
- Department of Medical Oncology, Armed Forces Hospital South Region, Khamis Mushait, SAU
| | - Waleed Bahaj
- Department of Medical Oncology, Oncology Center, King Abdullah Medical City, Makkah, SAU
| | - Hosam A Alghanmi
- Department of Medical Oncology, Oncology Center, King Abdullah Medical City, Makkah, SAU
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11
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Simanke CD, DaCás E, Bussyguin DS, Belizário AC, de Alencar ED, Tomasich FDS, Skare T, Nisihara R. Presentation Patterns and Outcomes in Patients with Colorectal Cancer Seeking the Emergency Department for Consultation. JOURNAL OF COLOPROCTOLOGY 2022. [DOI: 10.1055/s-0042-1757772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Abstract
Background Patients with colorectal cancer may seek the emergency department for symptoms related to chemotherapy and radiotherapy side effects as well as those from the disease itself and from surgery complications.
Objectives To establish the epidemiological and clinical profile of colorectal cancer patients that look for consultations in the emergency department.
Methods Retrospective study of emergency room charts from colorectal cancer patients that consulted in a single oncological hospital for the period of 1 year.
Results Four hundred and forty-six consultations were identified (49.5% males and 50.5% females) with a mean age of 63 years and with advanced disease (most with tumor, node, metastases [TNM] stages III and IV). The most common complaint was abdominal pain (27.5%), followed by nausea (4.7%; more commonly seen in females with p = 0.03) and bladder symptoms (4.7%; more commonly seen in males, with p = 0.003). Infections (10.3%) and acute abdominal pain (9.1%) were the most frequent diagnoses. About 18% of them were admitted to the hospital and 80% were discharged home.
Conclusion The profile of patients with colorectal cancer seeking the emergency department comprises patients with advanced disease and a similar proportion of males and females. Symptom-driven complaints were the most frequent reason for consultations.
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Affiliation(s)
| | - Eduardo DaCás
- Department of Medicine, Universidade Positivo, Curitiba, PR, Brazil
| | | | | | | | - Flavio D. S. Tomasich
- Department of Surgery, Abdominal Surgery Unit, Hospital Erasto Gaertner, Curitiba, PR, Brazil
| | - Thelma Skare
- Department of Medicine, Mackenzie Evangelical School of Medicine, Curitiba, PR, Brazil
| | - Renato Nisihara
- Department of Medicine, Universidade Positivo, Curitiba, PR, Brazil
- Department of Medicine, Mackenzie Evangelical School of Medicine, Curitiba, PR, Brazil
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12
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Workina A, Habtamu A, Zewdie W. Reasons for Emergency Department Visit, Outcomes, and Associated Factors of Oncologic Patients at Emergency Department of Jimma University Medical Centre. Open Access Emerg Med 2022; 14:581-590. [PMID: 36330170 PMCID: PMC9624217 DOI: 10.2147/oaem.s381816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 10/19/2022] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION The number of oncologic patients visiting the emergency department (ED) is increasing and represent a challenge for the emergency team owing to they might have acute sign and symptoms of a still undiagnosed malignancy, management of treatment-related side effects, co-morbidities, and palliative care. Thus, this study was aimed to identify reasons for ED visits, management outcomes, and associated factors of oncologic patients. PATIENTS AND METHODS A prospective cross-sectional study was conducted from March 11, 2021 to August 25, 2021 at the ED of Jimma University Medical Center on a total of 338 oncologic patients. Data were collected from the patient and the patient's medical record using a questionnaire developed from up-to-date similar literatures. The questionnaire was started filled out upon diagnosis of cancer and completed during discharge from the ED. The outcomes of the patients were dichotomized into died and survived then, it was analyzed using frequency and bivariate logistic regression. RESULTS The most common reasons for oncologic patients ED visit were neutropenic fever 79 (23.4%) followed by vomiting 38 (11.2%) and electrolyte abnormality 37 (10.9%) respectively. Among oncologic patients visited ED, 137 (40.5%) of them were admitted to ward and 126 (37.3%) of them were discharged with improvement while 64 (18.9%) of them were died. Based on multivariate logistic regression, those patients who had distant metastasis cancer (AOR 1.85; 95% CI 1.03-7.21), comorbidity (AOR 2.56; 95% CI 1.20, 6.96), and ECOG >3 (AOR 2.40; 95% CI 1.25,13.43) were more likely to die than their counterparts. CONCLUSION Most of the oncologic patients visited ED due to neutropenic fever, nausea and or vomiting, and electrolyte disorder. Amongst oncologic patients who were visited ED, most of them were admitted to ward while around one-fifth of them were died. Having distant metastasis cancer, comorbidity and ECOG >3 were independent predictors of an oncologic patient's outcome at the ED.
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Affiliation(s)
- Abdata Workina
- Department of Nursing, Jimma University, Jimma, Oromia, Ethiopia,Correspondence: Abdata Workina, Department of Nursing, Jimma University, Jimma University, P.O. Box-378, Jimma, Oromia, Ethiopia, Tel +251923643857, Email
| | - Asaminew Habtamu
- Department of Nursing, Jimma University, Jimma, Oromia, Ethiopia
| | - Wondeson Zewdie
- Department of Emergency, Jimma University Medical Centre, Jimma, Oromia, Ethiopia
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13
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de Santis RB, Wainstein AJA, Machado GCOG, Santos FAV, Melo MRP, Drummond‐Lage AP. Cancer patients admitted in the emergency department: A single‐centre observational study. Eur J Cancer Care (Engl) 2022; 31:e13758. [DOI: 10.1111/ecc.13758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 10/03/2022] [Accepted: 10/09/2022] [Indexed: 12/24/2022]
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14
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Teggart K, Bryant-Lukosius D, Neil-Sztramko SE, Ganann R. Implementation strategies to address barriers to evidence-informed symptom management among outpatient oncology nurses: a scoping review protocol. BMJ Open 2022; 12:e057661. [PMID: 35487756 PMCID: PMC9058794 DOI: 10.1136/bmjopen-2021-057661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Despite 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 ANALYSIS This 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 DISSEMINATION Ethics 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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Affiliation(s)
- Kylie Teggart
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Denise Bryant-Lukosius
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada
| | - Sarah E Neil-Sztramko
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Rebecca Ganann
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
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15
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Noyes K, Zapf AL, Depner RM, Flores T, Huston A, Rashid HH, McNeal D, Constine LS, Fleming FJ, Wilding GE, Sahler OJZ. Problem-solving skills training in adult cancer survivors: Bright IDEAS-AC pilot study. Cancer Treat Res Commun 2022; 31:100552. [PMID: 35358820 PMCID: PMC9106910 DOI: 10.1016/j.ctarc.2022.100552] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/19/2022] [Accepted: 03/22/2022] [Indexed: 05/13/2023]
Abstract
PURPOSE Cancer patients experience significant distress and burden of decision-making throughout treatment and beyond. These stressors can interfere with their ability to make reasoned and timely decisions about their care and lead to low physical and social functioning and poor survival. This pilot study examined the impact of offering Problem-Solving Skills Training (PSST) to adult cancer survivors to help them and their caregivers cope more successfully with post-treatment decision-making burden and distress. PATIENTS AND METHODS Fifty patients who completed their definitive treatment for colorectal, breast or prostate cancer within the last 6 months and reported distress (level > 2 on the National Comprehensive Cancer Network distress thermometer) were randomly assigned to either care as usual (CAU) or 8 weekly PSST sessions. Patients were invited to include a supportive other (n = 17). Patient and caregiver assessments at baseline (T1), end of intervention or 3 months (T2), and at 6 months (T3) focused on problem-solving skills, anxiety/depression, quality of life and healthcare utilization. We compared outcomes by study arm and interviewed participants about PSST burden and skill maintenance. RESULTS Trial participation rate was 60%; 76% of the participants successfully completed PSST training. PSST patients reported reduction in anxiety/depression, improvement in QoL (p < 0.05) and lower use of hospital and emergency department services compared to CAU patients (p = 0.04). CONCLUSIONS The evidence from this pilot study indicates that a remotely delivered PSST is a feasible and potentially effective strategy to improve mood and self-management in cancer survivors in community oncology settings.
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Affiliation(s)
- Katia Noyes
- University at Buffalo, Buffalo, NY, United States of America.
| | - Alaina L Zapf
- University of Rochester Medical Center, Rochester, NY, United States of America
| | - Rachel M Depner
- Alpert Medical School of Brown University, Providence, RI, United States of America
| | - Tessa Flores
- Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States of America
| | - Alissa Huston
- University of Rochester Medical Center, Rochester, NY, United States of America
| | - Hani H Rashid
- University of Rochester Medical Center, Rochester, NY, United States of America
| | - Demetria McNeal
- University of Colorado Anschutz Medical Campus, Aurora, CO, United States of America
| | - Louis S Constine
- University of Rochester Medical Center, Rochester, NY, United States of America
| | - Fergal J Fleming
- University of Rochester Medical Center, Rochester, NY, United States of America
| | | | - Olle Jane Z Sahler
- University of Rochester Medical Center, Rochester, NY, United States of America
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16
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The Value Proposition of Observation Medicine in Managing Acute Oncologic Pain. Curr Oncol Rep 2022; 24:595-602. [PMID: 35192121 DOI: 10.1007/s11912-022-01245-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW Despite recommended best practice guidelines, pain remains an ongoing but undertreated symptom in patients with cancer, many of whom require emergency department evaluation for acute oncologic pain. A significant proportion of these patients are hospitalized for pain management, which increases healthcare costs and exposes patients to the risks of hospitalization. We reviewed the literature on observation medicine: an emerging mode of healthcare delivery which can offer patients with acute pain access to a hospital's pain management solutions and specialists without an inpatient hospitalization. Specifically, we appraised the role of observation medicine in acute pain management and its financial implications in order to consider its potential impact on the management of acute oncologic pain. RECENT FINDINGS Recent evidence shows that observation medicine has the potential to decrease short-stay hospitalizations in cancer patients presenting with various concerns, including pain. Observation medicine is reported to be successful in providing comprehensive and cost-effective care for non-cancer patients with acute pain, making it a promising alternative to short-stay hospitalizations for cancer patients with acute oncologic pain.
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Zhuang Q, Chan JSE, See LKY, Chiang J, Suhaimi SR, Chua TWL, Venkataraman A. Characteristics of unplanned hospitalisations among cancer patients in Singapore. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2021; 50:882-891. [PMID: 34985100 DOI: 10.47102/annals-acadmedsg.2021212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Cancer is a pervasive global problem with significant healthcare utilisation and cost. Emergency departments (EDs) see large numbers of patients with oncologic emergencies and act as "gate-keepers" to subsequent hospital admissions. A proportion of such hospital admissions are rapidly discharged within 2 days and may be potentially avoidable. METHODS Over a 6-month period, we conducted a retrospective audit of active cancer patients presenting to the ED with subsequent admission to the Department of Medical Oncology. Our aims were to identify independent factors associated with a length of stay ≤2 days; and characterise the clinical and resource needs of these short admissions. RESULTS Among all medical oncology admissions, 24.4% were discharged within 2 days. Compared to longer stayers, patients with short admissions were significantly younger (P=0.010), had lower National Early Warning Scores (NEWS) (P=0.006), and had a lower proportion of gastrointestinal and hepatobiliary cancers (P=0.005). Among short admissions, common presenting medical problems were infections (n=144, 36.3%), pain (n=116, 29.2%), gastrointestinal complaints (n=85, 21.4%) and respiratory complaints (n=76, 19.1%). These admissions required investigations and treatments already available at the ED. CONCLUSION Short admissions have low resource needs and may be managed in the ED. This may help save valuable inpatient bed-days and reduce overall healthcare costs.
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Affiliation(s)
- Qingyuan Zhuang
- Division of Supportive and Palliative Care, National Cancer Centre, Singapore
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