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Supportive Care in Cancer

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01-05-2017 | Original Article

Retrospective study of unplanned hospital admission for metastatic cancer patients visiting the emergency department

Authors: Tae Tanaka, Masataka Taguri, Soichi Fumita, Kunio Okamoto, Yoshio Matsuo, Hidetoshi Hayashi

Published in: Supportive Care in Cancer | Issue 5/2017

Abstract

Purpose

The purpose of the study was to identify factors that predict unplanned admission for metastatic cancer patients visiting the emergency department (ED).

Methods

Patients visiting the ED of a general hospital from April 2012 to March 2013 were investigated retrospectively. Data including demographics, vital signs, and laboratory measurements were collected from a chart review for each patient. Factors related to emergency admission were identified by univariate and multivariate analyses.

Results

A total of 15,716 individuals visiting the ED during the study period included 1244 (7.9%) patients with cancer. Among the 491 cancer patients with metastasis, univariate analysis revealed that emergency admission was significantly associated with an age of ≥76 years; an altered mental status; fever (≥38 °C); a blood oxygen saturation of <90%; a white blood cell (WBC) count of ≤2000 or ≥10,000/μL; hypoalbuminemia (≤2.5 g/dL); and elevated levels of aspartate aminotransferase (≥100 IU/L), blood urea nitrogen (≥25 mg/dL), and C-reactive protein (CRP, ≥10 mg/dL). Multivariate analysis identified age, an altered mental status, hypoxemia, an abnormal WBC count, and elevated CRP as putative independent predictive factors for emergency admission. The number of these five factors present was also correlated with 30-day mortality (c-statistic = 0.72).

Conclusions

Age, unconsciousness, hypoxemia, an abnormal WBC count, and elevated CRP were found to be associated with emergency admission and 30-day mortality for metastatic cancer patients. Prospective validation of a predictive scoring system based on these findings is warranted.

Stewart B, Wild CP (eds) International Agency for Research on Cancer, WHO (2014) World cancer report 2014 [online]. http://www.thehealthwell.info/node/725845. Accessed 11 Dec 2016

McKenzie H, Hayes L, White K, Cox K, Fethney J, Boughton M, Dunn J (2011) Chemotherapy outpatients’ unplanned presentations to hospital: a retrospective study. Support Care Cancer 19(7):963–969CrossRefPubMed

Barbera L, Taylor C, Dudgeon D (2010) Why do patients with cancer visit the emergency department near the end of life? CMAJ 182(6):563–568CrossRefPubMedPubMedCentral

Extermann M (2000) Measurement and impact of comorbidity in older cancer patients. Crit Rev Oncol Hematol 35(3):181–200CrossRefPubMed

Leak A, Mayer DK, Wyss A, Travers D, Waller A (2013) Why do cancer patients die in the emergency department?: an analysis of 283 deaths in NC EDs. Am J Hosp Palliat Care 30(2):178–182CrossRefPubMed

Mayer DK, Travers D, Wyss A, Leak A, Waller A (2011) Why do patients with cancer visit emergency departments? Results of a 2008 population study in North Carolina. J Clin Oncol 29(19):2683–2688CrossRefPubMedPubMedCentral

Payne RA, Abel GA, Guthrie B, Mercer SW (2013) The effect of physical multimorbidity, mental health conditions and socioeconomic deprivation on unplanned admissions to hospital: a retrospective cohort study. CMAJ 185(5):E221–E228CrossRefPubMedPubMedCentral

Yucel N, Sukru Erkal H, Sinem Akgun F, Serin M (2012) Characteristics of the admissions of cancer patients to emergency department. J BUON 17(1):174–179PubMed

Swenson KK, Rose MA, Ritz L, Murray CL, Adlis SA (1995) Recognition and evaluation of oncology-related symptoms in the emergency department. Ann Emerg Med 26(1):12–17CrossRefPubMed

10.

Sadik M, Ozlem K, Huseyin M, AliAyberk B, Ahmet S, Ozgur O (2014) Attributes of cancer patients admitted to the emergency department in one year. World Journal of Emergency Medicine 5(2):85–90CrossRefPubMedPubMedCentral

11.

Kotajima F, Kobayashi K, Sakaguchi H, Nemoto M (2014) Lung cancer patients frequently visit the emergency room for cancer-related and -unrelated issues. Mol Clin Oncol 2(2):322–326PubMedPubMedCentral

12.

Geraci JM, Tsang W, Valdres RV, Escalante CP (2006) Progressive disease in patients with cancer presenting to an emergency room with acute symptoms predicts short-term mortality. Support Care Cancer 14(10):1038–1045CrossRefPubMed

13.

Porta M, Fernandez E, Belloc J, Malats N, Gallen M, Alonso J (1998) Emergency admission for cancer: a matter of survival? Br J Cancer 77(3):477–484CrossRefPubMedPubMedCentral

14.

Rondeau DF, Schmidt TA (2009) Treating cancer patients who are near the end of life in the emergency department. Emerg Med Clin North Am 27(2):341–354CrossRefPubMed

15.

Azoulay E, Moreau D, Alberti C, Leleu G, Adrie C, Barboteu M, Cottu P, Levy V, Le Gall J-R, Schlemmer B (2000) Predictors of short-term mortality in critically ill patients with solid malignancies. Intensive Care Med 26(12):1817–1823. doi:10.1007/s001340051350 CrossRefPubMed

16.

Darmon M, Azoulay E, Alberti C, Fieux F, Moreau D, Gall J-R, Schlemmer B (2002) Impact of neutropenia duration on short-term mortality in neutropenic critically ill cancer patients. Intensive Care Med 28(12):1775–1780CrossRefPubMed

17.

Weaver C, Schiech L, Held-Warmkessel J, Kedziera P, Haney E, DiLullo G, Babb JS, Ruth K, Dell D, Barsevick A (2006) Risk for unplanned hospital readmission of patients with cancer: results of a retrospective medical record review. Oncol Nurs Forum 33(3):E44–E52CrossRefPubMed

18.

Repetto L, Fratino L, Audisio RA, Venturino A, Gianni W, Vercelli M, Parodi S, Dal Lago D, Gioia F, Monfardini S, Aapro MS, Serraino D, Zagonel V (2002) Comprehensive geriatric assessment adds information to Eastern Cooperative Oncology Group performance status in elderly cancer patients: an Italian Group for Geriatric Oncology Study. J Clin Oncol 20(2):494–502CrossRefPubMed

19.

Tsushima T, Hironaka S, Boku N, Machida N, Yamazaki K, Yasui H, Taku K, Fukutomi A, Onozawa Y (2010) Safety and efficacy of S-1 monotherapy in elderly patients with advanced gastric cancer. Gastric Cancer 13(4):245–250CrossRefPubMed

20.

Ahn S, Lee YS, Lim KS, Lee JL (2012) Emergency department cancer unit and management of oncologic emergencies: experience in Asan Medical Center. Support Care Cancer 20(9):2205–2210CrossRefPubMed

21.

Delgado-Guay MO, Rodriguez-Nunez A, Shin SH, Chisholm G, Williams J, Frisbee-Hume S, Bruera E (2016) Characteristics and outcomes of patients with advanced cancer evaluated by a palliative care team at an emergency center. A retrospective study. Support Care Cancer 24(5):2287–2295CrossRefPubMed

22.

Kuderer NM, Dale DC, Crawford J, Cosler LE, Lyman GH (2006) Mortality, morbidity, and cost associated with febrile neutropenia in adult cancer patients. Cancer 106(10):2258–2266CrossRefPubMed

23.

Masaoka T (2004) Evidence-based recommendations for antimicrobial use in febrile neutropenia in Japan: executive summary. Clin Infect Dis 39(Suppl 1):S49–S52CrossRefPubMed

24.

Strange GR, Chen EH, Sanders AB (1992) Use of emergency departments by elderly patients: projections from a multicenter data base. Ann Emerg Med 21(7):819–824CrossRefPubMed

25.

Grant M, Ferrell BR, Rivera LM, Lee J (1995) Unscheduled readmissions for uncontrolled symptoms. A health care challenge for nurses. Nurs Clin North Am 30(4):673–682PubMed

26.

Kurtz ME, Kurtz JC, Given CW, Given BA (2005) Utilization of services among elderly cancer patients—relationship to age, symptoms, physical functioning, comorbidity, and survival status. Ethn Dis 15(2 Suppl 2):S17–S22PubMed

27.

Thiery G, Azoulay E, Darmon M, Ciroldi M, De Miranda S, Levy V, Fieux F, Moreau D, Le Gall JR, Schlemmer B (2005) Outcome of cancer patients considered for intensive care unit admission: a hospital-wide prospective study. J Clin Oncol 23(19):4406–4413CrossRefPubMed

28.

Staudinger T, Stoiser B, Mullner M, Locker GJ, Laczika K, Knapp S, Burgmann H, Wilfing A, Kofler J, Thalhammer F, Frass M (2000) Outcome and prognostic factors in critically ill cancer patients admitted to the intensive care unit. Crit Care Med 28(5):1322–1328CrossRefPubMed

29.

Fu S, Hong DS, Naing A, Wheler J, Falchook G, Wen S, Howard A, Barber D, Nates J, Price K, Kurzrock R (2011) Outcome analyses after the first admission to an intensive care unit in patients with advanced cancer referred to a phase I clinical trials program. J Clin Oncol 29(26):3547–3552CrossRefPubMed

30.

Ramchandran KJ, Shega JW, Von Roenn J, Schumacher M, Szmuilowicz E, Rademaker A, Weitner BB, Loftus PD, Chu IM, Weitzman S (2013) A predictive model to identify hospitalized cancer patients at risk for 30-day mortality based on admission criteria via the electronic medical record. Cancer 119(11):2074–2080CrossRefPubMed

31.

Suh SY, Ahn HY (2007) A prospective study on C-reactive protein as a prognostic factor for survival time of terminally ill cancer patients. Support Care Cancer 15(6):613–620CrossRefPubMed

32.

Gripp S, Moeller S, Bolke E, Schmitt G, Matuschek C, Asgari S, Asgharzadeh F, Roth S, Budach W, Franz M, Willers R (2007) Survival prediction in terminally ill cancer patients by clinical estimates, laboratory tests, and self-rated anxiety and depression. J Clin Oncol 25(22):3313–3320CrossRefPubMed

33.

Escalante CP, Martin CG, Elting LS, Price KJ, Manzullo EF, Weiser MA, Harle TS, Cantor SB, Rubenstein EB (2000) Identifying risk factors for imminent death in cancer patients with acute dyspnea. J Pain Symptom Manag 20(5):318–325CrossRef

34.

Grimm RH Jr, Neaton JD, Ludwig W (1985) Prognostic importance of the white blood cell count for coronary, cancer, and all-cause mortality. JAMA 254(14):1932–1937CrossRefPubMed

35.

Vigano A, Bruera E, Jhangri GS, Newman SC, Fields AL, Suarez-Almazor ME (2000) Clinical survival predictors in patients with advanced cancer. Arch Intern Med 160(6):861–868CrossRefPubMed

36.

Suh SY, Ahn HY (2007) Lactate dehydrogenase as a prognostic factor for survival time of terminally ill cancer patients: a preliminary study. Eur J Cancer 43(6):1051–1059CrossRefPubMed

Title: Retrospective study of unplanned hospital admission for metastatic cancer patients visiting the emergency department
Authors: Tae Tanaka
Masataka Taguri
Soichi Fumita
Kunio Okamoto
Yoshio Matsuo
Hidetoshi Hayashi
Publication date: 01-05-2017
Publisher: Springer Berlin Heidelberg
Published in: Supportive Care in Cancer / Issue 5/2017
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI: https://doi.org/10.1007/s00520-016-3535-1

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Conclusions

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