Reasons and Associated Factors for Emergency Room Visits of Cancer Patients in a Tertiary Hospital, Thailand

Authors

  • Thammasin Ingviya Department of Family and Preventive Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand. Division of Digital Innovation and Data Analytics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand.
  • Chanavee Toh Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand.
  • Suppalerk Chavasiri Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand.
  • Orapan Fumaneeshoat Department of Family and Preventive Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand.

DOI:

https://doi.org/10.31584/jhsmr.2022892

Keywords:

cancer, chief complaint, ER visits, palliative care, symptoms

Abstract

Objective: To investigate the reasons leading cancer patients to visit an emergency room (ER) and the associated factors, which will suggest policies to reduce unnecessary ER visits.
Material and Methods: A cross-sectional study was done in Songklanagarind Hospital, the major referral center in Southern Thailand. The data of cancer patients aged 18 years or older diagnosed during 2011 to 2018 were retrieved from our Hospital Information System. The reasons for the ER visits were defined and classified using the “chief complaints” from doctors’ notes. A negative binomial regression model was used to assess factors associated with the ER visits.
Results: A total of 42,574 cancer patients were identified during the study period. 8,307 (19.5%) had visited the ER at least once. The most common cancer type was of the digestive organs (28.1%). The top 5 reasons for an ER visit were pain (25.4%), dyspnea (11.5%), abdominal discomfort (6.0%), fever (5.9%), and stoma and catheter device-related problems (5.2%). The most common factors associated with ER visits were age, metastasis, palliative chemotherapy or radiotherapy, previous hospitalization, years with cancer, type of cancer and healthcare scheme.
Conclusion: Pain and dyspnea were the two most common chief complaints leading cancer patients to visit the ER. These two symptoms should be given special attention in cancer patients, especially those receiving chemotherapy or radiation, to ensure they are well controlled and do not lead to unnecessary ER visits.

References

World Health Organization. Global health estimates: leading causes of death [homepage on Internet]. Geneva: WHO; 2020 [cited 2021 May 26]. Available from: https://www.who.int/data/ maternal-newborn-child-adolescent-ageing/advisory-groups/ gama/gama-advisory-group-members

Cuthbert CA, Boyne DJ, Yuan X, Hemmelgarn BR, Cheung WY. Patient-reported symptom burden and supportive care needs at cancer diagnosis: a retrospective cohort study. Support Care Cancer 2020;28:5889–99.

Philip J, Remedios C, Breen S, Weiland T, Willenberg L, Boughey M, et al. The experiences of patients with advanced cancer and caregivers presenting to Emergency Departments: A qualitative study. Palliat Med 2018;32:439–46.

Caterino JM, Adler D, Durham DD, Yeung S-CJ, Hudson MF, Bastani A, et al. Analysis of diagnoses, symptoms, medications, and admissions among patients with cancer presenting to Emergency Departments. JAMA Netw Open 2019;2:e190979.

Henson LA, Higginson IJ, Daveson BA, Ellis-Smith C, Koffman J, Morgan M, et al. ‘I’ll be in a safe place’: a qualitative study of the decisions taken by people with advanced cancer to seek emergency department care. BMJ Open 2016;6:e012134.

Cooper E, Hutchinson A, Sheikh Z, Taylor P, Townend W, Johnson MJ. Palliative care in the emergency department: a systematic literature qualitative review and thematic synthesis. Palliat Med 2018;32:1443–54.

Young A, Marshall E, Krzyzanowska M, Robinson B, Brown S, Collinson F, et al. Responding to acute care needs of patients with cancer: recent trends across continents. Oncologist 2016;21:301–7.

Ferrell BR, Temel JS, Temin S, Alesi ER, Balboni TA, Basch EM, 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.

Higdon ML, Atkinson CJ, Lawrence KV. Oncologic emergencies: recognition and initial management. AFP 2018;97:741–8.

Gallaway MS, Idaikkadar N, Tai E, Momin B, Rohan EA, Townsend J, et al. Emergency department visits among people with cancer: frequency, symptoms, and characteristics. JACEP Open 2021;2:e12438.

Yang Z, Yang R, Kwak MJ, Qdaisat A, Lin J, Begley CE, et al. Oncologic emergencies in a cancer center emergency department and in general emergency departments countywide and nationwide. PLoS One 2018;13:e0191658.

Hsu J, Donnelly JP, Xavier Moore J, Meneses K, Williams G, Wang HE. National characteristics of emergency eepartment visits by patients with cancer in the United States. Am J Emerg Med 2018;36:2038–43.

Koo MM, von Wagner C, Abel GA, McPhail S, Hamilton W, Rubin GP, et al. The nature and frequency of abdominal symptoms in cancer patients and their associations with time to help-seeking: evidence from a national audit of cancer diagnosis. J Public Health (Oxf) 2018;40:e388–95. 14. Batalini F, Gomes M, I F, Kuwae F, Macanhan G, Pereira JLB. Cancer complaints: the profile of patients from the emergency department of a Brazilian oncology teaching hospital. F1000Res 2017;6:1919.

van den Beuken-van Everdingen MHJ, Hochstenbach LMJ, Joosten EAJ, Tjan-Heijnen VCG, Janssen DJA. Update on prevalence of pain in patients with cancer: systematic review and meta-analysis. J Pain Symptom Manage 2016;51:1070-90.e9.

Barbera L, Atzema C, Sutradhar R, Seow H, Howell D, Husain A, et al. Do patient-reported symptoms predict emergency department visits in cancer patients? A population-based analysis. Ann Emerg Med 2013;61:427-37.e5.

Lavand’homme P. The progression from acute to chronic pain. Curr Opin Anaesthesiol 2011;24:545–50.

Fallon M, Giusti R, Aielli F, Hoskin P, Rolke R, Sharma M, et al. Management of cancer pain in adult patients: ESMO clinical practice guidelines. Ann Oncol 2018;29:iv166–91.

Mills S, Buchanan D, Guthrie B, Donnan P, Smith B. Factors affecting use of unscheduled care for people with advanced cancer: a retrospective cohort study in Scotland. Br J Gen Pract 2019;69:e860–8.

Chavan PP, Kedia SK, Yu X. Impact of physical and functional limitations on health care utilization in older cancer survivors: a medicare current beneficiary survey. J Aging Health 2020;32:987–97.

Rogers MJ, Matheson LM, Garrard B, Mukaro V, Riches S, Sheridan M, et al. Cancer diagnosed in the emergency department of a regional health service. Aust J Rural Health 2016;24:409–14.

Markar SR, Mackenzie H, Jemal S, Faiz O, Cunningham D, Hanna GB. Emergency presentation of esophagogastric cancer: predictors and long-term prognosis. Ann Surg 2018;267:711–5.

Chan W, Lam K, Siu W, Yuen K. Chemotherapy at end-of-life: an integration of oncology and palliative teams. Support Care Cancer 2016;24:1421–7.

Wu C-C, Hsu T-W, Chang C-M, Lee C-H, Huang C-Y, Lee C-C. Palliative chemotherapy affects aggressiveness of end of-life care. Oncologist 2016;21:771–7.

Wu SY, Singer L, Boreta L, Garcia MA, Fogh SE, Braunstein SE. Palliative radiotherapy near the end of life. BMC Palliative Care 2019;18:29.

Bayrak Aykan E, Kitiş Y. The main reasons for emergency department visits in cancer patients. Haseki Tıp Bülteni 2018;56:6–13.

Spencer K, Parrish R, Barton R, Henry A. Palliative radiotherapy. BMJ 2018;360:k821.

Dilalla V, Chaput G, Williams T, Sultanem K. Radiotherapy side effects: integrating a survivorship clinical lens to better serve patients. Curr Oncol 2020;27:107–12.

Grewal K, Krzyzanowska MK, McLeod S, Borgundvaag B, Atzema CL. Outcomes after emergency department use in patients with cancer receiving chemotherapy in Ontario, Canada: a population-based cohort study. CMAJ Open 2020;8:E496–505.

Hui D, Hannon BL, Zimmermann C, Bruera E. Improving patient and caregiver outcomes in oncology: Team-based, timely, and targeted palliative care. CA Cancer J Clin 2018;68:356–76.

Evangelista CB, Lopes MEL, Costa SFG da, Batista PS de S, Batista JBV, Oliveira AM de M. Palliative care and spirituality: an integrative literature review. Rev Bras Enferm 2016;69:591–601.

Haun MW, Estel S, Rücker G, Friederich H-C, Villalobos M, Thomas M, et al. Early palliative care for adults with advanced cancer. Cochrane Database Syst Rev 2017;6:CD011129.

Hsu H-S, Wu T-H, Lin C-Y, Lin C-C, Chen T-P, Lin W-Y. Enhanced home palliative care could reduce emergency department visits due to non-organic dyspnea among cancer patients: a retrospective cohort study. BMC Palliative Care 2021;20:42.

Verhoef M-J, de Nijs E, Horeweg N, Fogteloo J, Heringhaus C, Jochems A, et al. Palliative care needs of advanced cancer patients in the emergency department at the end of life: an observational cohort study. Support Care Cancer 2020;28:1097–107.

Grudzen CR, Richardson LD, Johnson PN, Hu M, Wang B, Ortiz JM, et al. Emergency department-initiated palliative care in advanced cancer: a randomized clinical trial. JAMA Oncol 2016;2:591–8. 36. Grudzen C, Richardson LD, Baumlin KM, Winkel G, Davila C, Ng K, et al. Redesigned geriatric emergency care may have helped reduce admissions of older adults to intensive care units. Health Aff (Millwood) 2015;34:788–95.

Sripaew S, Fumaneeshoat O, Ingviya T. Systematic adaptation of the Thai version of the supportive and palliative care indicators tool for low-income setting (SPICT-LIS). BMC Palliative Care 2021;20:35.

Baik D, Russell D, Jordan L, Dooley F, Bowles KH, Masterson Creber RM. Using the palliative performance scale to estimate survival for patients at the end of life: a systematic review of the literature. J Palliat Med 2018;21:1651–61.

Downloads

Published

2023-04-19

How to Cite

1.
Ingviya T, Toh C, Chavasiri S, Fumaneeshoat O. Reasons and Associated Factors for Emergency Room Visits of Cancer Patients in a Tertiary Hospital, Thailand. J Health Sci Med Res [Internet]. 2023 Apr. 19 [cited 2024 Dec. 23];41(1):1-17. Available from: https://he01.tci-thaijo.org/index.php/jhsmr/article/view/263070

Issue

Section

Original Article