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Numico G, Ferrua R, Fea E, Giamello J, Colantonio I, Occelli M, Vandone AM, Vanella P, Aimar G, Pisano C, Parlagreco E, Persano I, Milanesio M, Ippoliti R. Patients with cancer and hospital admissions: disease trajectory and strategic choices. BMJ Support Palliat Care 2023:spcare-2023-004574. [PMID: 37704262 DOI: 10.1136/spcare-2023-004574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 08/28/2023] [Indexed: 09/15/2023]
Abstract
OBJECTIVES Hospital admission (HA) in cancer history is a common, repeated and frequently unplanned event. The emergency departments (EDs) and the oncological outpatient service (OOS) are the ordinary way of entry. We studied the reasons of admission, pathways of access and discharge and prognostic factors in a population of admitted patients with cancer. METHODS The health records of the admitted patients in the oncological ward of a referral hospital in a 6-month period were retrieved and analysed. The characteristics of those admitted in the last 3 months of life were compared with the other group. RESULTS Among the 147 HA, 79.5% were unplanned, 48.9% passing through the ED and 30.6% through the OOS; 56.5% were due to cancer-related symptoms; 50.3% occurred in the last 3 months of life. Median overall survival was 90 days (95% IC 53.1-126.9). Independent prognostic factors for survival were: being admitted for symptoms, referral through the ED and not being discharged at home. CONCLUSIONS Hospital is a turning point in the cancer care pathway. Patients needing HA have a dismal prognosis, half of them being in the last 3 months of life. This group can be identified using universally available variables.
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Affiliation(s)
| | | | - Elena Fea
- Medical Oncology, AO S.Croce e Carle, Cuneo, Italy
| | | | | | | | | | | | | | | | | | | | | | - Roberto Ippoliti
- Department of Jurisprudence and Political Economic and Social Sciences, University of Eastern Piedmont Amedeo Avogadro, Alessandria, Piemonte, Italy
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Lash R, Pettit N, Vachon E, Spackman C, Draucker CB. A qualitative analysis of cancer-related patient care in the emergency department. Acad Emerg Med 2023; 30:842-850. [PMID: 36809571 DOI: 10.1111/acem.14706] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 02/02/2023] [Accepted: 02/20/2023] [Indexed: 02/23/2023]
Abstract
OBJECTIVES Due to an increasing incidence of new cancer diagnoses in the United States and longer survivorship, a growing number of patients with cancer receive care in emergency departments (EDs). This trend places an increasing burden on already crowded EDs, and experts are concerned these patients do not receive optimal care. The purpose of this study was to describe the experiences of ED physicians and nurses who care for patients with cancer. This information can inform strategies to improve oncology care for patients in ED settings. METHODS We used a qualitative descriptive design to summarize to the experiences of ED physicians and nurses (n = 23) caring for patients with cancer. We conducted individual, semistructured interviews to query participants about their perspectives on care for oncology patients in the ED. RESULTS Physician and nurse participants identified 11 challenges and suggested three potential strategies to improve care. The challenges included the following: risk of infection, poor communication between ED staff and other providers, poor communication between oncology or primary care providers and patients, poor communication between ED providers and patients, difficult disposition decisions, new cancer diagnoses, complex pain management, allocation of limited resources, lack of cancer-specific skills among providers, poor care coordination, and evolving end-of-life decisions. The solutions included the following: patient education, education for ED providers, and improved care coordination. CONCLUSIONS Physicians and nurses experience challenges stemming from three overarching types of factors: illness factors, communication factors, and system-level factors. Solutions for the challenges of providing oncology care in the ED call for new strategies at the levels of the patient, provider, institution, and health care system.
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Affiliation(s)
- Rebecca Lash
- Children's Hospital Los Angeles, Los Angeles, California, USA
- Indiana University School of Nursing, Fort Wayne, Indiana, USA
| | - Nick Pettit
- Department of Emergency Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Eric Vachon
- Center for Health Services Research, Regenstrief Institute, Indianapolis, Indiana, USA
- Indiana University School of Nursing, Indianapolis, Indiana, USA
| | - Candice Spackman
- Indiana University School of Nursing, Indianapolis, Indiana, USA
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Koch M, Szabó É, Varga C, Soós V, Prenek L, Porcsa L, Bellyei S, Girán K, Girán J, Kiss I, Pozsgai É. Retrospective study of cancer patients' predictive factors of care in a large, Hungarian tertiary care centre. BMJ Open 2023; 13:e070320. [PMID: 37156589 PMCID: PMC10174014 DOI: 10.1136/bmjopen-2022-070320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
Abstract
OBJECTIVES To identify predictive factors of multiple emergency department (ED) visits, hospitalisation and potentially preventable ED visits made by patients with cancer in a Hungarian tertiary care centre. DESIGN Observational, retrospective study. SETTING A large, public tertiary hospital, in Somogy County, Hungary, with a level 3 emergency and trauma centre and a dedicated cancer centre. PARTICIPANTS Patients above 18 years with a cancer diagnosis (International Classification of Diseases, 10th Revision codes of C0000-C9670) who visited the ED in 2018, who had received their diagnosis of cancer within 5 years of their first ED visit in 2018 or received their diagnosis of cancer latest within the study year. Cases diagnosed with cancer at the ED (new cancer diagnosis-related ED visits) were also included, constituting 7.9% of visits. PRIMARY OUTCOME MEASURES Demographic and clinical characteristics were collected and the predictors of multiple (≥2) ED visits within the study year, admission to inpatient care following the ED visit (hospitalisation), potentially preventable ED visits and death within 36 months were determined. RESULTS 2383 ED visits made by 1512 patients with cancer were registered. Predictive factors of multiple (≥2) ED visits were residing in a nursing home (OR 3.09, 95% CI 1.88 to 5.07) and prior hospice care (OR 1.87, 95% CI 1.05 to 3.31). Predictive factors for hospitalisation following an ED visit included a new cancer diagnosis-related visit (OR 1.86, 95% CI 1.30 to 2.66) and complaint of dyspnoea (OR 1.61, 95% CI 1.22 to 2.12). CONCLUSIONS Being a resident of a nursing home and receiving prior hospice care significantly increased the odds of multiple ED visits, while new cancer-related ED visits independently increased the odds of hospitalisation of patients with cancer. This is the first study to report these associations from a Central-Eastern European country. Our study may shed light on the specific challenges of EDs in general and particularly faced by countries in the region.
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Affiliation(s)
- Márton Koch
- Department of Emergency Medicine, Somogy County Kaposi Mór General Hospital, Kaposvár, Hungary
| | - Éva Szabó
- Department of Otorhinolaryngology, University of Pécs Clinical Center, Pecs, Hungary
| | - Csaba Varga
- Department of Emergency Medicine, Somogy County Kaposi Mór General Hospital, Kaposvár, Hungary
- Department of Emergency Medicine, Semmelweis University, Budapest, Hungary
| | - Viktor Soós
- Department of Emergency Medicine, Somogy County Kaposi Mór General Hospital, Kaposvár, Hungary
| | - Lilla Prenek
- Department of Emergency Medicine, Somogy County Kaposi Mór General Hospital, Kaposvár, Hungary
| | - Lili Porcsa
- Department of Emergency Medicine, Somogy County Kaposi Mór General Hospital, Kaposvár, Hungary
| | - Szabolcs Bellyei
- Department of Oncotherapy, University of Pécs Clinical Center, Pecs, Hungary
| | - Kyra Girán
- Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, The Netherlands
| | - János Girán
- Department of Public Health, Pécsi Tudományegyetem Általános Orvostudományi Kar, Pecs, Hungary
| | - István Kiss
- Department of Public Health, Pécsi Tudományegyetem Általános Orvostudományi Kar, Pecs, Hungary
| | - Éva Pozsgai
- Department of Public Health, Pécsi Tudományegyetem Általános Orvostudományi Kar, Pecs, Hungary
- Department of Primary Health Care, Pécsi Tudományegyetem Általános Orvostudományi Kar, Pecs, Hungary
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Cancer-related emergency and urgent care: expanding the research agenda. EMERGENCY CANCER CARE 2022; 1:4. [PMID: 35844668 PMCID: PMC9194780 DOI: 10.1186/s44201-022-00005-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 04/23/2022] [Indexed: 11/17/2022]
Abstract
Purpose of review Cancer-related emergency department (ED) visits often result in higher hospital admission rates than non-cancer visits. It has been estimated many of these costly hospital admissions can be prevented, yet urgent care clinics and EDs lack cancer-specific care resources to support the needs of this complex population. Implementing effective approaches across different care settings and populations to minimize ED and urgent care visits improves oncologic complication management, and coordinating follow-up care will be particularly important as the population of cancer patients and survivors continues to increase. The National Cancer Institute (NCI) and the Office of Emergency Care (OECR) convened a workshop in December 2021, “Cancer-related Emergency and Urgent Care: Prevention, Management, and Care Coordination” to highlight progress, knowledge gaps, and research opportunities. This report describes the current landscape of cancer-related urgent and emergency care and includes research recommendations from workshop participants to decrease the risk of oncologic complications, improve their management, and enhance coordination of care. Recent findings Since 2014, NCI and OECR have collaborated to support research in cancer-related emergency care. Workshop participants recommended a number of promising research opportunities, as well as key considerations for designing and conducting research in this area. Opportunities included better characterizing unscheduled care services, identifying those at higher risk for such care, developing care delivery models to minimize unplanned events and enhance their care, recognizing cancer prevention and screening opportunities in the ED, improving management of specific cancer-related presentations, and conducting goals of care conversations. Summary Significant progress has been made over the past 7 years with the creation of the Comprehensive Oncologic Emergency Research Network, broad involvement of the emergency medicine and oncology communities, establishing a proof-of-concept observational study, and NCI and OECR’s efforts to support this area of research. However, critical gaps remain.
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Son MH, Chung HS. Chief complaints of patients with cancer who visit the emergency department over their oncologist's outpatient clinic in South Korea. BMC Palliat Care 2022; 21:54. [PMID: 35449052 PMCID: PMC9027837 DOI: 10.1186/s12904-022-00946-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 04/14/2022] [Indexed: 11/26/2022] Open
Abstract
Background There have been several reports of patients with cancer visiting the Emergency Department (ED) rather than the outpatient department of their oncologist. In this study, we aimed to analyze the chief complaints, visit time, and time spent in the ED between study groups of patients with cancer visiting the ED. This finding will help medical staff provide better care for patients with cancer and reduce time spent in the ED. Methods A total of 787 patients with cancer visited the Regional Emergency Medical Center between January 1, 2020, and December 31, 2020. After the exclusion criterion such as patients who were transferred to the ED with a referral issued slip, patients who were pregnant women or minors under the age of 18 were applied, data from 607 patients with cancer were collected retrospectively from electronic medical records at the hospital. The participating patients with cancer were divided into two groups: 1) ED group—those who were cared for by the ED physician and 2) Referral group—those who were referred to their oncologist for hospitalization. Results We found that 40% of the total patients with cancer included in the study visited the ED with a chief complaint of pain. It was observed that the highest frequency of visits to the ED was around noon during clinic hours. The length of ED stay was 169 and 566 min for the ED and referral groups, respectively. Conclusion It would be more beneficial for patients with cancer visiting the ED to be quickly discharged from the ED physician’s active care for their symptoms. This usage of ED services will reduce unnecessary waiting time.
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Affiliation(s)
- Min Hyun Son
- Department of Emergency Medicine, College of Medicine, Yeungnam University, 170 Hyeonchung-ro, Nam-gu, Daegu, 42415, Republic of Korea
| | - Han Sol Chung
- Department of Emergency Medicine, College of Medicine, Yeungnam University, 170 Hyeonchung-ro, Nam-gu, Daegu, 42415, Republic of Korea.
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