Acute symptoms including pain, nausea and shortness of breath drive some 4.5 million cancer patients to seek treatment in U.S. emergency rooms annually with many admitted to hospitals, a recent study found.
Conducted at 18 U.S. emergency departments including Strong Memorial Hospital’s in Rochester, the study was published in the Journal of the American Medical Association’s JAMA Network Open online journal. It analyzed the ED experiences of 1,075 cancer patients over a 12-month span from Feb. 1, 2016 to Jan. 30 2017.
Thought to be the first investigation of its type, the study unearthed at least one “system failure” in cancer treatment, says David Adler M.D., University of Rochester Medical Center professor of emergency medicine.
Adler led the study at URMC and was the second-cited author of the JAMA Network Open article. The research was led nationally by Ohio State University’s Wexner Medical Center.
Adler sees the investigators’ findings that only a tiny fraction—8 percent—of patients studied were engaged in palliative care and more than half had not signed an advanced directive as pointing a systemic deficit in U.S. cancer treatment.
Palliative care focuses on reducing patients’ pain and maximizing quality of life, aims that could mean forgoing possibly life-prolonging but stressful therapies. Advanced directives guide providers on how patients who cannot communicate want to be treated. Lacking such guidelines, physicians could be obligated to apply all means necessary to keep a patient alive.
“Whether the issue lies with primary care doctors or oncologists, or others,” says Adler, “the problem is that when a cancer patient gets to the emergency department it may be too late to see this through.”
Sponsored by the National Institutes of Health’s National Cancer Institute, the study’s main goal as to “accelerate knowledge generation as well as design, execution, and translation of oncologic emergency medicine research,” the online JAMA article states. ED visits resulted in a hospital admission with 25 percent staying two days or less.
Citing cost and health benefits of reducing hospitalizations, the federal Center for Medicare and Medicaid Services has long sought to cut hospital admissions, offering financial incentives to hospitals to reduce length of stay and cut admissions.
The study estimates that 4.5 million cancer patients seek ED treatment annually. That accounts for approximately 1 percent of all U.S. ED visits, which the Centers for Disease Control and Prevention estimates at 145.6 million.
The relatively high rate of cancer patient admissions could point to a need for better coordination among oncologists and other providers treating cancer patients, Adler says.
“ED doctors may choose to admit cancer patients to guarantee that the patient connects with a specialist or an oncologist as soon as possible,” he adds. “If you discharge a patient, it allows for risk of inadequate follow-up, especially if the person lives in a rural or underserved area.”
Better coordination among primary care providers, oncologists, palliative care specialists and ED physicians is needed, the study concludes.
URMC, OSU’s Wexner Center and the 16 other academic medical centers that participated in the study are members of the National Cancer Institute-sponsored Comprehensive Oncologic Emergencies Research Network.
Will Astor is Rochester Beacon senior writer.