1896P - Importance of prompt medical oncologist (MO) consultation at the Emergency Department (ED): A prospective study in a tertiary hospital on 10,896 admissions in the first quarter of 2024

Background

Management of cancer patients at the ED has long been problematic, especially with regard to the intensity of care for patients near the end of life. We sought to investigate the utility of MO consultation at the ED in indicating the best supportive care for cancer patients.

Methods

Consecutive MO consultations with patients presented to the ED from January 1 to March 31, 2024 were recorded. MO indication of best supportive care (BSC) was correlated with overall survival (OS) and 30-day mortality rate (30-DMR). Additionally, 47 clinical and laboratory candidate variables were collected and correlated with OS. Significant variables (p ≤0.005) selected at univariate analysis were analyzed in a multivariate Cox-regression model.

Results

Out of 10,896 adult ED visits, MO consultation was required in 120 visits (1.1% of cases) well below the 5% prevalence of cancer patient ED visits reported in the literature). The most common cancers for which consultation was required were lung, gastrointestinal, and genitourinary cancer, and most common presenting symptoms were pain (25%), dyspnea (25%), and neurological symptoms (19%). Following MO consultation, BSC was indicated in 47.8% of cases. BSC indication was associated to a significantly higher 30-DMR compared to active treatment indication: 25% vs 13%, HR 3.01 (95%CI: 1.34 to 6.71), p 0.007. Following univariate analysis, alkaline phosphatase (ALP), neutrophils-to-lymphocyte ratio, Charlson comorbidity index, concomitant infection and modified Glasgow prognostic score (mGPS) were selected for the multivariate model and ALP >100 IU/L (HR 5.28, 95%CI: 1.73-16.12, p 0.003) and mGPS score 2 (HR 12.78, 95%CI: 2.89-56.53, p 0.0008) were confirmed to be independent predictors of OS. Among patients eligible to active treatment, those with ALP>100 and/or mGPS=2 had a 30-DMR of 22% vs 6% of patients with ALP<100 and mGPS 0/1.

Conclusions

Early MO consultation is strongly recommended for the appropriate management of cancer patients in the Emergency Room. ALP and mGPS may assist prognostication in this setting.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.