Palliative Care Needs and Clinical Outcomes of Patients with Advanced Cancer in the Emergency Department

Sule Yilmaz¹, Corita R Grudzen², Danielle D Durham³, Caroline McNaughton⁴, Isabelle Marcelin², Beau Abar⁵, David Adler⁵, Aveh Bastani⁶, Christopher W Baugh⁷, Steven L Bernstein⁸, Jason J Bischof⁹, Christopher J Coyne¹⁰, Daniel J Henning¹¹, Matthew F Hudson¹², Adam Klotz¹³, Gary H Lyman¹⁴, Troy E Madsen¹⁵, Daniel J Pallin⁷, Cielito Reyes-Gibby¹⁶, Juan Felipe Rico¹⁷, Richard J Ryan¹⁸, Nathan I Shapiro¹⁹, Robert Swor²⁰, Charles R Thomas²¹, Arvind Venkat²², Jason Wilson²³, Sai-Ching Jim Yeung¹⁶, Jeffrey M Caterino²⁴

Affiliations

¹ Division of Supportive Care in Cancer, Department of Surgery, University of Rochester Medical Center, Rochester, New York, USA.
² Ronald O. Perelman Department of Emergency Medicine and Population Health, New York University School of Medicine, New York, New York, USA.
³ Department of Radiology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA.
⁴ University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA.
⁵ Department of Emergency Medicine, University of Rochester, Rochester, New York, USA.
⁶ Department of Emergency Medicine, William Beaumont Hospital-Troy Campus, Troy, Michigan, USA.
⁷ Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
⁸ Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA.
⁹ Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
¹⁰ Department of Emergency Medicine, University of California San Diego, San Diego, California, USA.
¹¹ Department of Emergency Medicine, University of Washington, Seattle, Washington, USA.
¹² Prisma Health Cancer Institute, Greenville, South Carolina, USA.
¹³ Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
¹⁴ Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center and the Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA.
¹⁵ Division of Emergency Medicine, University of Utah, Salt Lake City, Utah, USA.
¹⁶ Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
¹⁷ Department of Pediatrics, University of South Florida Morsani College of Medicine, Tampa, Florida, USA.
¹⁸ Department of Emergency Medicine, University of Cincinnati, Cincinnati, Ohio, USA.
¹⁹ Department of Emergency Medicine, Beth Israel Deaconness Medical Center, Boston, Massachusetts, USA.
²⁰ Department of Emergency Medicine, William Beaumont Hospital, Royal Oak, Michigan, USA.
²¹ Department of Radiation Medicine, Knight Cancer Institute, Oregon Health and Sciences University, Portland, Oregon, USA.
²² Department of Emergency Medicine, Allegheny Health Network, Pittsburgh, Pennsylvania, USA.
²³ Department of Emergency Medicine, University of South Florida Morsani College of Medicine, Tampa, Florida, USA.
²⁴ Department of Emergency Medicine and Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.

PMID: 35559758
PMCID: PMC9467631
DOI: 10.1089/jpm.2021.0567

Palliative Care Needs and Clinical Outcomes of Patients with Advanced Cancer in the Emergency Department

Sule Yilmaz et al. J Palliat Med. 2022 Jul.

. 2022 Jul;25(7):1115-1121.

doi: 10.1089/jpm.2021.0567. Epub 2022 May 13.

Authors

Affiliations

¹ Division of Supportive Care in Cancer, Department of Surgery, University of Rochester Medical Center, Rochester, New York, USA.
² Ronald O. Perelman Department of Emergency Medicine and Population Health, New York University School of Medicine, New York, New York, USA.
³ Department of Radiology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA.
⁴ University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA.
⁵ Department of Emergency Medicine, University of Rochester, Rochester, New York, USA.
⁶ Department of Emergency Medicine, William Beaumont Hospital-Troy Campus, Troy, Michigan, USA.
⁷ Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
⁸ Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA.
⁹ Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
¹⁰ Department of Emergency Medicine, University of California San Diego, San Diego, California, USA.
¹¹ Department of Emergency Medicine, University of Washington, Seattle, Washington, USA.
¹² Prisma Health Cancer Institute, Greenville, South Carolina, USA.
¹³ Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
¹⁴ Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center and the Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA.
¹⁵ Division of Emergency Medicine, University of Utah, Salt Lake City, Utah, USA.
¹⁶ Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
¹⁷ Department of Pediatrics, University of South Florida Morsani College of Medicine, Tampa, Florida, USA.
¹⁸ Department of Emergency Medicine, University of Cincinnati, Cincinnati, Ohio, USA.
¹⁹ Department of Emergency Medicine, Beth Israel Deaconness Medical Center, Boston, Massachusetts, USA.
²⁰ Department of Emergency Medicine, William Beaumont Hospital, Royal Oak, Michigan, USA.
²¹ Department of Radiation Medicine, Knight Cancer Institute, Oregon Health and Sciences University, Portland, Oregon, USA.
²² Department of Emergency Medicine, Allegheny Health Network, Pittsburgh, Pennsylvania, USA.
²³ Department of Emergency Medicine, University of South Florida Morsani College of Medicine, Tampa, Florida, USA.
²⁴ Department of Emergency Medicine and Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.

PMID: 35559758
PMCID: PMC9467631
DOI: 10.1089/jpm.2021.0567

Abstract

Background: Older adults with cancer use the emergency department (ED) for acute concerns. Objectives: Characterize the palliative care needs and clinical outcomes of advanced cancer patients in the ED. Design: A planned secondary data analysis of the Comprehensive Oncologic Emergencies Research Network (CONCERN) data. Settings/Subjects: Cancer patients who presented to the 18 CONCERN affiliated EDs in the United States. Measurements: Survey included demographics, cancer type, functional status, symptom burden, palliative and hospice care enrollment, and advance directive code status. Results: Of the total (674/1075, 62.3%) patients had advanced cancer and most were White (78.6%) and female (50.3%); median age was 64 (interquartile range 54-71) years. A small proportion of them were receiving palliative (6.5% [95% confidence interval; CI 3.0-7.6]; p = 0.005) and hospice (1.3% [95% CI 1.0-3.2]; p = 0.52) care and had a higher 30-day mortality rate (8.3%, [95% CI 6.2-10.4]). Conclusions: Patients with advanced cancer continue to present to the ED despite recommendations for early delivery of palliative care.

Keywords: advanced cancer; cohort study; oncologic emergency medicine; palliative care.

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Conflict of interest statement

Dr. Yeung was a member of an expert panel for Celgene, Inc. Dr. Yeung had funding support from Bristol-Myer Squibb, Inc., and DepoMed, Inc. All other authors declare no competing financial or nonfinancial interests.

References

1. Hsu J, Donnelly J, Moore JX, et al. : National characteristics of Emergency Department visits by patients with cancer in the United States. Am J Emerg Med 2018;36:2038–2043. - PMC - PubMed
1. Rivera DR, Gallicchio L, Brown J, et al. : Trends in adult cancer-related emergency department utilization: An analysis of data from the Nationwide Emergency Department Sample. JAMA Oncol 2017;3. - PMC - PubMed
1. Ferrell BR, Temel J, Temin S, et al. : Integration of palliative care into standard oncology care: American Society of Clinical Oncology Clinical Practice Guideline Update. J Clin Oncol 2017;35:96–112. - PubMed
1. George N, Bowman J, Aaronson E, and Ouchi K: Past, present, and future of palliative care in emergency medicine in the USA. Acute Med Surg 2020;7:e497. - PMC - PubMed
1. Lamba S, DeSandre PL, Todd KH, et al. : Integration of palliative care into emergency medicine: The Improving Palliative Care in Emergency Medicine (IPAL-EM) Collaboration. J Emerg Med 2014;46:264–270. - PubMed

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Palliative Care Needs and Clinical Outcomes of Patients with Advanced Cancer in the Emergency Department

Affiliations

Palliative Care Needs and Clinical Outcomes of Patients with Advanced Cancer in the Emergency Department

Authors

Affiliations

Abstract

Conflict of interest statement

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical