Reasons for Emergency Department Use by Oncology Patients Inconsistently Defined 

Reasons for visits to the emergency department (ED) vary among patients with cancer, and more research is needed to illuminate potentially preventable emergency department (PPED) visits in this patient population, according to a systematic review published in The Oncologist. 

The researchers sought to investigate those factors not well-described in the literature that contribute to ED visits among oncology patients. Three online databases were searched for studies that focused on PPEDs, novel cancer therapies, and patient-level variables, including receiving supportive care alone. 

A total of 45 studies were included in the analysis. All of the studies were published in English between 2012 and 2022. 

Thirty-one studies included treatment-associated characteristics of ED use, with 6 reporting significant predictors. Common treatment-related predictors were cytotoxic chemotherapy, receipt of 3 or more agents, and concurrent chemoradiation treatment. ED visits were more common during the first cycle than during the second and third cycles. 

Additionally, up to 70% of patients with immunotherapy made approximately 3 ED visits per patient. 

Disease-related factors, reported by 39 studies, were primary cancer site. Lung cancer was associated with higher ED use (7% to 64.9%), and these patients had 3-fold higher odds of visiting the ED compared with patients with hematologic cancers (13.4% to 52.5%). 

Other common cancer types associated with high ED use included melanoma (28.4%), liver cancer (12.2% to 13.1%), gastrointestinal (GI) cancers (9% to 68%), and prostate (5.3% to 13.8%) and other genitourinary cancers (6% to 26.3%).

Thirty-three studies identified significant patient-level factors. Patients who were married (up to 89%), employed (55.6%), and who reported having sufficient income (45.3%) were likely to visit the ED. Other factors included age (up to 53.6% were aged 65 to 74 years) and race (White patients, 55.0% to 93.1%).

Reasons for the ED visit included pain (up to 66%), and GI complications (2.7% to 62%), dyspnea (3.6% to 16.9%). Infection/fever and nausea/vomiting also were common. 

Reports of pain was higher in patients with prostate cancer (19.7%) compared with all other diagnoses. 

Pain and GI complaints were higher among younger patients (18 to 44 years and 45 to 64 years); and respiratory, neurologic, and injury complaints were higher in patients aged 65 and older.

Common complaints associated with higher ED use among patients receiving immunotherapy included fatigue (79%), nausea/emesis (45%), arthralgia (32%), diarrhea/colitis (26% to 56.3%), grades 1-2 hepatitis (24.5%), acute kidney injury (17%), skin reaction (15%), hypothyroidism (13.2%), neurologic issues (13.2%), and thrombocytopenia (11%), as well as hyperthyroidism, neutropenia, and pneumonitis.

More than half of patients (55.2%) with cancer who visited the ED made return visits for the same symptom(s). PPEDs were the most common among patients receiving cytotoxic chemotherapy (20%) and those with breast cancer (13.4%).  

“The literature reporting on PPED visits is heterogeneous, and definitions of such visits vary significantly.… However, for the studies that did include this concept, it was consistent that the main patient ED presentation in such cases was for pain,” the authors concluded. 

The researchers noted that significant gaps continue to exist when it comes to research and knowledge on ED usage by patients with cancer patients, with few studies focusing on novel therapies and the impact on ED usage.  

Additionally, the existing literature is focused more on patients undergoing active systemic treatment, resulting in the exclusion of patients receiving supportive care only, including end-of-life patients.

Disclosures: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.