Skip to main content
SpringerLink
Log in

Presentation patterns and outcomes of patients with cancer accessing care in emergency departments in Victoria, Australia

  • Original Article
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Purpose

People with cancer attend emergency departments (EDs) for many reasons. Improved understanding of the specific needs of these patients may assist in optimizing health service delivery. ED presentation and hospital utilization characteristics were explored for people with cancer and compared with those patients without cancer.

Methods

This descriptive, retrospective, multicentre cohort study used hospital administrative data. Descriptive and inferential statistics were used to summarise and compare ED presentation characteristics amongst cancer and non-cancer groups. Predictive analyses were used to identify ED presentation features predictive of hospital admission for cancer patients. Outcomes of interest were level of acuity, ED and inpatient length of stay, re-presentation rates and admission rates amongst cancer patients and non-cancer patients.

Results

ED (529,377) presentations occurred over the 36 months, of which 2.4 % (n = 12,489) were cancer-related. Compared with all other attendances, cancer-related attendances had a higher level of acuity, requiring longer management time and length of stay in ED. Re-presentation rates for people with cancer were nearly double those of others (64 vs 33 %, p < 0.001), with twice the rate of hospital admission (90 vs 46 %, p < 0.001), longer inpatient length of stay (5.6 vs 2.8 days, p < 0.001) and had higher inpatient mortality (7.9 vs 1.0 %, p < 0.001). Acuity and arriving by ambulance were significant predictors of hospital admission, with cancer-related attendances having ten times the odds of admission compared to other attendances (OR = 10.4, 95 % CI 9.8–11.1).

Conclusions

ED presentations by people with cancer represent a more urgent, complex caseload frequently requiring hospital admission when compared to other presentations, suggesting that for optimal cancer care, close collaboration and integration of oncology, palliative care and emergency medicine providers are needed to improve pathways of care.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Australian Institute of Health and Welfare (2013) Australian hospital statistics 2012–13: emergency department care. Health services series no. 52. AIHW, Canberra

    Google Scholar 

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

    Article  Google Scholar 

  3. Guddati AK, Kumar N, Segon A, Joy PS, Marak CP, Kumar G (2013) Identifying oncological emergencies. Med Oncol (Northwood, London, England) 30(3):669. doi:10.1007/s12032-013-0669-6

    Article  Google Scholar 

  4. Chan A, Soh D, Ko Y, Huang YC, Chiang J (2014) Characteristics of unplanned hospital admissions due to drug-related problems in cancer patients. Support Care Cancer 22(7):1875–1881. doi:10.1007/s00520-014-2160-0

    Article  PubMed  Google Scholar 

  5. 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):2683–2688. doi:10.1200/jco.2010.34.2816

    Article  PubMed Central  PubMed  Google Scholar 

  6. International Statistical Classification of Diseases and Related Health Problems. 10th Revision. Australian Modification (ICD-10-AM) (2010) National Centre for Classification in Health (NCCH). http://sydney.edu.au/health_sciences/ncch/index.shtml. Accessed 20 April 2015

  7. Barbera L, Atzema C, Sutradhar R, Seow H, Howell D, Husain A, Sussman J, Earle C, Liu Y, Dudgeon D (2013) Do patient-reported symptoms predict emergency department visits in cancer patients? A population-based analysis. Ann Emerg Med 61(4):427–437. doi:10.1016/j.annemergmed.2012.10.010, e425

    Article  PubMed  Google Scholar 

  8. 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):12–17

    Article  CAS  PubMed  Google Scholar 

  9. Tanriverdi O, Beydilli H, Yildirim B, Karagoz U (2014) Single center experience on causes of cancer patients visiting the emergency department in southwest Turkey. Asian Pac J Cancer Prev APJCP 15(2):687–690

    Article  PubMed  Google Scholar 

  10. Tsai SC, Liu LN, Tang ST, Chen JC, Chen ML (2010) Cancer pain as the presenting problem in emergency departments: incidence and related factors. Support Care Cancer 18(1):57–65. doi:10.1007/s00520-009-0630-6

    Article  PubMed  Google Scholar 

  11. Yates M, Barrett A (2009) Oncological emergency admissions to the Norfolk and Norwich University Hospital: an audit of current arrangements and patient satisfaction. Clin Oncol (Royal College of Radiologists (Great Britain)) 21(3):226–233. doi:10.1016/j.clon.2008.12.006

    Article  CAS  Google Scholar 

  12. Vandyk AD, Harrison MB, Macartney G, Ross-White A, Stacey D (2012) Emergency department visits for symptoms experienced by oncology patients: a systematic review. Support Care Cancer 20(8):1589–1599. doi:10.1007/s00520-012-1459-y

    Article  PubMed  Google Scholar 

  13. McNamara BA, Rosenwax LK, Murray K, Currow DC (2013) Early admission to community-based palliative care reduces use of emergency departments in the ninety days before death. J Pall Med 16(7):774–779. doi:10.1089/jpm.2012.0403

    Article  Google Scholar 

  14. Rosenwax LK, McNamara BA, Murray K, McCabe RJ, Aoun SM, Currow DC (2011) Hospital and emergency department use in the last year of life: a baseline for future modifications to end-of-life care. Med J Aust 194(11):570–573

    PubMed  Google Scholar 

  15. Livingston P, Craike M, Considine J (2011) Unplanned presentations to emergency departments due to chemotherapy induced complications: opportunities for improving service delivery. Australas Emerg Nurs J 14:62–68. doi:10.1016/j.aenj.2011.03.005

    Article  Google Scholar 

  16. 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):963–969. doi:10.1007/s00520-010-0913-y

    Article  PubMed  Google Scholar 

  17. 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 Pall Care 30(2):178–182. doi:10.1177/1049909112445306

    Article  Google Scholar 

  18. Aprile G, Pisa FE, Follador A, Foltran L, De Pauli F, Mazzer M, Lutrino S, Sacco CS, Mansutti M, Fasola G (2013) Unplanned presentations of cancer outpatients: a retrospective cohort study. Support Care Cancer 21(2):397–404. doi:10.1007/s00520-012-1524-6

    Article  CAS  PubMed  Google Scholar 

  19. Flowers CR, Seidenfeld J, Bow EJ, Karten C, Gleason C, Hawley DK, Kuderer NM, Langston AA, Marr KA, Rolston KV, Ramsey SD (2013) Antimicrobial prophylaxis and outpatient management of fever and neutropenia in adults treated for malignancy: American society of clinical oncology clinical practice guideline. J Clin Oncol 31(6):794–810. doi:10.1200/jco.2012.45.8661

    Article  PubMed  Google Scholar 

  20. Jefford M, Baravelli C, Dudgeon P, Dabscheck A, Evans M, Moloney M, Schofield P (2008) Tailored chemotherapy information faxed to general practitioners improves confidence in managing adverse effects and satisfaction with shared care: results from a randomized controlled trial. J Clin Oncol 26(14):2272–2277. doi:10.1200/jco.2007.14.7710

    Article  PubMed  Google Scholar 

  21. Gorham J, Ameye L, Berghmans T, Sculier JP, Meert AP (2013) The lung cancer patient at the emergency department: a three-year retrospective study. Lung Cancer 80(2):203–208. doi:10.1016/j.lungcan.2012.12.006

    Article  CAS  PubMed  Google Scholar 

  22. Courtney DM, Aldeen AZ, Gorman SM, Handler JA, Trifilio SM, Parada JP, Yarnold PR, Bennett CL (2007) Cancer-associated neutropenic fever: clinical outcome and economic costs of emergency department care. Oncologist 12(8):1019–1026. doi:10.1634/theoncologist.12-8-1019

    Article  PubMed  Google Scholar 

  23. Perrone J, Hollander JE, Datner EM (2004) Emergency department evaluation of patients with fever and chemotherapy-induced neutropenia. J Emerg Med 27(2):115–119. doi:10.1016/j.jemermed.2004.03.004

    Article  PubMed  Google Scholar 

  24. Demshar R, Vanek R, Mazanec P (2011) Oncologic emergencies: new decade, new perspectives. AACN Adv Crit Care 22(4):337–348. doi:10.1097/NCI.0b013e318230112b

    Article  PubMed  Google Scholar 

  25. van den Beuken-van Everdingen MH, de Rijke JM, Kessels AG, Schouten HC, van Kleef M, Patijn J (2007) Prevalence of pain in patients with cancer: a systematic review of the past 40 years. Ann Oncol 18(9):1437–1449. doi:10.1093/annonc/mdm056

    Article  Google Scholar 

  26. Greenwald HP, Bonica JJ, Bergner M (1987) The prevalence of pain in four cancers. Cancer 60(10):2563–2569

    Article  CAS  PubMed  Google Scholar 

  27. Jelinek GA, Marck CH, Weiland TJ, Philip J, Boughey M, Weil J, Lane H (2013) Caught in the middle: tensions around the emergency department care of people with advanced cancer. Emerg Med Australas 25(2):154–160. doi:10.1111/1742-6723.12047

    Article  PubMed  Google Scholar 

  28. Gabriel J (2012) Acute oncological emergencies. Nurs Stand 27(4):35–42

    Article  CAS  PubMed  Google Scholar 

  29. 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):2205–2210. doi:10.1007/s00520-012-1478-8

    Article  PubMed  Google Scholar 

  30. Ruegg TA (2013) A nurse practitioner-led urgent care center: meeting the needs of the patient with cancer. Clin J Oncol Nurs 17(4):E52–E57. doi:10.1188/13.CJON.E52-E57

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This study was supported financially by a grant from the Victorian Comprehensive Cancer Centre.

Conflict of interest

The authors have no financial relationship with the funding agency and have no conflicts of interest to disclose. The authors have full control of all primary data and agree to allow the journal to review their data if requested.

Authorship contributions

All authors contributed equally, and each was involved in study design, data acquisition or data analysis/interpretation and in drafting or critically revising the manuscript. All authors reviewed the final manuscript and gave approval for submission.

Author information

Authors and Affiliations

  1. Emergency Practice Innovation Centre, St. Vincent’s Hospital, PO Box 2900, Fitzroy, Melbourne, VIC, 3065, Australia

    Dania M. van der Meer, Tracey J. Weiland, George A. Jelinek & Claudia H. Marck

  2. Department of Medicine, The University of Melbourne (St. Vincent’s Hospital), Melbourne, Victoria, Australia

    Tracey J. Weiland & George A. Jelinek

  3. Palliative Medicine, St. Vincent’s Hospital, Melbourne, Victoria, Australia

    Jennifer Philip, Mark Boughey, Jennifer L. Weil & Heather P. Lane

  4. Centre for Palliative Care, The University of Melbourne, Melbourne, Victoria, Australia

    Jennifer Philip, Mark Boughey & Jennifer L. Weil

  5. Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia

    George A. Jelinek

  6. Emergency Department, Royal Melbourne Hospital, Melbourne, Victoria, Australia

    Jonathan Knott

  7. Department of Oncology, St. Vincent’s Hospital, Melbourne, Victoria, Australia

    Anthony J. Dowling

  8. Joseph Epstein Centre for Emergency Medicine Research at Western Health, Sunshine Hospital, Victoria, Australia

    Anne-Maree Kelly

Authors
  1. Dania M. van der Meer
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tracey J. Weiland
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jennifer Philip
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. George A. Jelinek
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mark Boughey
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jonathan Knott
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Claudia H. Marck
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Jennifer L. Weil
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Heather P. Lane
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Anthony J. Dowling
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Anne-Maree Kelly
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to George A. Jelinek.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

van der Meer, D.M., Weiland, T.J., Philip, J. et al. Presentation patterns and outcomes of patients with cancer accessing care in emergency departments in Victoria, Australia. Support Care Cancer 24, 1251–1260 (2016). https://doi.org/10.1007/s00520-015-2921-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-015-2921-4

Keywords

Search

Navigation