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Examining Top Reasons for Cancer-Related ED Visits

Laura Joszt
While it is known that febrile neutropenia is the most common reason for pediatric patients with cancer visiting the emergency department (ED), little had been known about the most common reasons for adult patients with cancer ending up in the ED.
When one of the 15.5 million people with cancer experiences a cancer-related complication, he or she is usually treated in the emergency department (ED). A recent study in JAMA Oncology examined the trends of adult cancer-related ED utilization to understand the factors that relate to inpatient admission.

The authors pointed out that the most common primary reason for 294,289 cancer-related visits to the ED from 2006 to 2010, in the pediatric population, was febrile neutropenia.

In a previous interview with The American Journal of Managed Care®, Daniel J. DeAngelo, MD, JD, of Harvard Medical School and the Dana-Farber Cancer Institute, who was not involved in the study, explained that patients with febrile neutropenia are often admitted to the hospital and started on antibiotics.

“Patients with neutropenia are at a risk of infection, sepsis, bacteremia, and the cost is hospitalization, broad-spectrum antibiotics, often anti-fungal therapy,” he explained. “And many patients become profoundly sick with sepsis or sepsis-like syndrome, requiring an intensive care stay.”

However, there is a gap in knowledge and in the evidence of how to care for patients with cancer in the ED. The study in JAMA Oncology sought to understand the overall utilization of the ED by patients with cancer, the clinical presentation of patients with cancer who end up in the ED, and factors associated with inpatient admission.

The authors found that patients with breast cancer had the highest frequency of ED visits, followed by prostate and other male genital cancers, lung cancer, and then patients with multiple cancers. From January 2006 and December 2012, 4.2% of ED visits by adult members of the population were related to cancer. The mean number of adult cancer-related visits per year for the 7 years studied was 4.2 million.

While the most common reason for pediatric patients with cancer visiting the ED was febrile neutropenia, the researchers found the most common reasons for adults with cancer to visit the ED was pneumonia, nonspecific chest pain, urinary tract infection, septicemia, and chronic obstructive pulmonary disease. Septicemia was the most common condition that resulted in inpatient admission. Overall, 59.7% of cancer-related ED visits resulted in an inpatient admission.

“Cancer care delivery research should focus on the significantly higher inpatient admission rate of cancer-related ED visits (59.7%) compared with noncancer ED visits,” the authors concluded. “Further study is needed to better describe cancer-related ED visits and to identify subpopulations in which ED physicians and oncologists can work together to improve patient care.”

 
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