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Presentation and treatment of patients with active cancer presenting to the emergency departments of the comprehensive oncologic emergencies research network (concern-1) [Meeting Abstract]

Caterino, J M; Bernstein, S L; Reyes-Gibby, C; Guyette, M; Venkat, A; Bastani, A; Baugh, C W; Coyne, C J; Klotz, A; Adler, D; Madsen, T; Wilson, J; Henning, D J; Quest, T; Shapiro, N I; Grudzen, C
Background: There is little data on presentation of and care for oncology patients in the ED. Our goal was to describe the characteristics and dispositions of patients with active cancer who present to EDs of the Comprehensive ONCologic Emergencies Research Network. Methods: Prospective, observational study of patients >=18 years of age with active cancer in 19 US tertiary-care EDs. A patient survey was administered in the ED, and a 30-day chart review identified ED course, comorbidities, revisits, and outcomes. Descriptive statistics were calculated. Results: We enrolled 616 patients, with 364 having complete 30 day chart reviews. The population was 50% female, 13% African-American, 3% Asian, and 7% Hispanic. Mean age was 63 years with 291 >=65. The most common cancer types were gastrointestinal (22%), breast (12%), and lung (10%). Almost half (47%) had no living will or advanced directive. In the week prior to ED visit, symptoms reported as present "quite a bit" or "very much" included pain (47%), shortness of breath (24%), and nausea (20%). ED symptom-related complaints were common including pain (69%), shortness of breath (38%), and nausea (34%). Ten percent reported fever >=100.4degree F prior to ED arrival. In the 364 subjects with completed chart reviews, 52% received pain medication and 31% nausea medication in the ED. Antibiotics were administered to 28% (n=99). ED disposition included admission in 64% (12% to step-down or ICU), observation in 7%, and discharge in 28%. 30-day mortality was 5.7% (95% CI 3.4-8.7%). 30-day ED revisit and hospital readmission rates were 27% and 23%.< Conclusion: ED patients with active cancer present with high acuity and substantial symptom burden including pain, nausea, and shortness of breath. Infection is a frequent concern in the ED with high rates of antibiotic administration. These patients have high admission, mortality, and revisit rates. Additional studies to identify optimal ED care and disposition practices for this population are warranted
EMBASE:616279763
ISSN: 1553-2712
CID: 2580022