Instituto do Câncer do Estado de São Paulo (ICESP) is a Brazilian university hospital dedicated to cancer treatment. Since there are about 19,000 outpatient appointments, 4,300 chemotherapy sessions and 5,400 radiotherapy sessions monthly, a focused emergency room (ER) has been created, so as to support ICESP patients. This study describes the main reasons that lead patients to ER, in order to improve medical assistance.
We performed a descriptive and retrospective cohort study, using medical records of all patients attended at the ER from 01/24/16 to 02/07/16, excluding ones referred from the day hospital unity. A two-way ANOVA (α = 0.05) was followed by a Fischer's LSD test to assess the prevalence of different cancer sites between regular appointments and ER visits.
In the period, 900 patients totalized 933 visits to the ER. The most frequent affections were pain (36.4%), fever (10.3%), muscle weakness (7.2%), dyspnea (6.5%), bleeding (4.5%) and swelling (4.0%). Most common ER patients cancer sites were colorectal (14.4%), breast (13.4%), head & neck (10.4%), hematological (10.3%), esophagus/ stomach (8.8%), lungs (7.2%), prostate (7.1%), urinary tract (6.0%) and liver/ bile ducts/ pancreas (5.7%), uterus (3.3%) and skin (2.9%). From 05/2008 to 08/2013, the most frequent diagnoses in ICESP were: prostate (14.8%), colorectal (12.5%), breast (12.1%), head & neck (9.2%), skin (8.4%), esophagus/ stomach (7.9%), lungs (6.5%) and hematological (6.0%). The most common cancer types treated in ICESP are also the ones most often seen in ER patients, but for prostate (p = 0.0082) and skin cancer (p = 0.0460), significantly less common in the ER than in regular appointments. Surprisingly, colorectal and breast cancer were the most frequent among patients in our ER, while most of them were under chemotherapy and so, visited the outpatient unity frequently during the same period. Initial tests did not exact link between complaints and tumor site.
Our study shows the most frequent complaints of cancer patients who visit our specialized ER and demand intervention for treatment or diagnosis. A deep analysis of final ER diagnoses is required, so that multidisciplinary, educative and preventive actions should be taken, in order to avoid visits to the ER.
Clinical trial identification
Legal entity responsible for the study
ICESP - Instituto do Câncer do Estado de São Paulo
All authors have declared no conflicts of interest.