5917 - Oncologic Emergency Medicine in the real world: A survey and proposal for improvement

Background

The increase in cancer survival and the development of new therapies has produced an increase in the hospital admissions through the Emergency Department (ED). To assess these patients and their outcome, we designed this study.

Methods

The records of patients admitted between July and November 2018 were studied. The following variables were registered: age, gender, comorbidities, type of cancer, stage, type and line of treatment, date of the last treatment, symptoms at admission, hospitalization length and outcome.

Results

170 patients (83 men and 87 women) entered the study. The mean age was 61.4 years. The most frequent diagnoses were: lung (20%), breast (17.1%), colo-rectal (14.7%) and pancreatic (12.4%) cancers. Stages: I – II (15.5%), III (10.6%) and IV (75.9%). Type of therapy: chemotherapy (74.1%), immunotherapy (9.4%), targeted therapy (16.5%) and homone therapy (2.4%). Line of therapy: neo- or adjuvant (18%), first (46.6%), second (18%), third (9.9%) and fourth or subsequent (7.5%). The most frequent symptoms at admission were: fever (31.4%), dyspnoea (14.8%) and pain 14.8%). Thirty seven point six percent of admissions were because of tumour related complications, 34.7% because of toxicity and 27.1% because of non-leukopenic infection. The mean hospitalization length were 10.3 days. From the 170 patients, 32 died in the hospital and 13 within the first month after discharge. Tumour progression was the cause of death in 75% of the cases and the complications of therapy was in 18.2%. Seventy five percent were receiving a third or subsequent line of therapy and 66.5% received chemotherapy in the last month of life.

Conclusions

Despite all patients were managed according the ESMO and NCCN guidelines, there is a necessity to improve the clinical decisions, in order to improve the patients’ quality of life and the uses of hospital resources. The establishment of Clinical Decision Units in the ED, could help to this goal. Or perhaps there is a “missing link” between guidelines and the real clinical practice.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

Manuel Morales González.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.