Lung cancer patients frequently visit the emergency room for cancer-related and -unrelated issues

Abstract

Lung cancer patients visit the emergency room (ER) for cancer-related and -unrelated reasons more often compared to patients with other types of cancer. This results in increased admissions and deaths in the ER. In this study, we retrospectively reviewed the characteristics of lung cancer patients visiting the ER in order to optimize the utilization of emergency medical services and improve the patients' quality of life. Lung cancer patients visiting the ER of a single institution over a 2-year period (2010-2011) were analyzed. The patients' chief complaints and diagnoses at presentation in the ER were classified as cancer-related and -unrelated. Hospital admission, discharge from the ER, hospital mortality and survival of advanced lung cancer patients hospitalized through admission to the ER was surveyed. A total of 113 patients visited the ER 143 times. Seventy visits (49.0%) were cancer-related and 73 (51.0%) were cancer-unrelated. Respiratory symptoms, pain, gastrointestinal and neurological events and fever were the most common cancer-related issues recorded. With the progression of cancer stage, the number of ER visits, admissions, ambulance use and hospital mortalities increased. In visits due to cancer-unrelated issues, including infection, cardiovascular and gastrointestinal diseases, fever was the most common complaint. Emergency admissions of advanced-stage patients for cancer-related issues revealed a significantly shorter median survival time compared to that for patients admitted for cancer-unrelated issues (61 vs. 406 days, respectively; P<0.05). It was observed that outpatients with lung cancer visited the ER for cancer-related and -unrelated reasons with a similar frequency. Therefore, accurate differential diagnosis in the ER is crucial for patients with lung cancer.

Keywords: advanced lung cancer; emergency diagnosis; emergency medical service; emergency room; lung cancer; oncologic emergency; palliative care; survival time.

Figure 1

Visits to the emergency room (ER) during each period of the day. Vertical bars, number of patients; dots, number of admissions by ambulance over the 3 periods of the 24-hour day. Approximately half of the patients visited the ER in the evening, although the number of ambulance cases and admissions did not differ according to time of day.

Figure 2

Frequency of chief complaints at the emergency room by cancer stage. The three major and other minor symptoms are summed to 100% in each cancer stage. Dyspnea occurred in almost half of stage I patients, fever was common among stage II/III patients and symptoms varied in stage IV patients.

Figure 3

Survival of stage IV lung cancer patients admitted from the emergency room. Solid line, survival curve of patients admitted for cancer-related issues; dotted line, survival curve of patients admitted for cancer-unrelated issues. The patients admitted for cancer-related reasons exhibited a significantly shorter median survival time compared to those admitted for cancer-unrelated issues (61 vs. 406 days, respectively; P<0.05).