Emergency care in oncology constitutes a significant burden for both patients and the healthcare system. The purpose of this study was to correlate clinical characteristics of patients with effective treatment in an oncology-dedicated emergency department (OED), as compared with a general emergency department (GED).
Electronic files of cancer patients who visited the OED and GED between April - June 2017 were retrospectively collected from the hospital registry, and efficacy parameters were compared between groups. Data obtained from a representative sample of patients in the OED were analyzed using descriptive statistics and logistic regressions to determine which factors were associated with successful or insufficient management in the OED alone.
The full cohort included 799 patients treated in both emergency settings. A total of 479 patients (60%) presented initially to the OED, and of these, 50 (10.4%) required referral to the GED. Compared with the OED, treatment in the GED was significantly associated with more consultations, imaging and hospitalizations (88% vs 16% p<0.001). In the OED, most patients were male and above age 60. Common diagnoses were lung (33%) gastrointestinal (30%) and breast (11%) cancer; 85% were metastatic. Treatment modalities included chemotherapy (59%), immunotherapy (16%) and biologics (16%). Pain was the most frequent chief complaint (45%), followed by gastrointestinal (33%), malaise (18%) and respiratory (15%). Most admissions were for management of disease symptoms (30%) and treatment side effects (18%). Characteristics associated higher referral to the GED included genitourinary cancer (56% p=0.031), biological therapy (64% p<0.001), back pain (80% p<0.001), neurological (60% p=0.010), and suspected oncological emergencies (79% p<0.001). Conversely, disease symptoms were well controlled in the OED (86% p=0.003), as treatment side effects and minor procedures.
The OED provides convenient, efficacious, cancer focused care. However, careful triage of patients is recommended, as diagnosis, symptoms, and admission type can predict referral to the GED. High-risk patients should avoid admission to the OED, which is better suited for urgent than emergent care.
Clinical trial identification
0465-17-RMB IRB approval granted November 12, 2017 Extended until December 13, 2020.
Legal entity responsible for the study
Friends of Rambam NPO.
All authors have declared no conflicts of interest.