Oral Presentation COSA-IPOS Joint Scientific Meeting 2012

Emergency department utilization by adult cancer patients: a retrospective cohort study (#150)

Amy Waller 1 2 , Barry Bultz 1 2 , Linda Carlson 1 2 , Shannon Groff 1 , Michael Prystajecky 3 , Eddy Lang 3 , Ayn Sinnarajah 4 , Alison Murray 4 , Jessica Simon 4 , Neil Hagen 4 , Bejoy Thomas 1
  1. Department of Psychosocial Resources, Tom Baker Cancer Centre, Calgary, Canada
  2. Department of Oncology, University of Calgary, Calgary, Canada
  3. Department of Emergency Medicine, University of Calgary, Calgary, Canada
  4. Palliative and End of Life Services, Alberta Health Services, Calgary, Canada

Background: Cancer patients are receiving a greater proportion of their care on an outpatient basis. The impact of this change in oncology care patterns on Emergency Department (ED) and palliative care (PC) utilization is poorly understood.
Objectives: To examine the rate of use of ED and PC services by adult cancer patients; and demographic and psychosocial predictors of each type of service use in the year following diagnosis.
Methods: Between July 2007 and March 2009, newly diagnosed adult cancer patients attending a tertiary care cancer centre were recruited into a longitudinal study examining distress. Patients were followed prospectively until March 2010. Collected demographic and psychosocial data was linked to administrative data on ED and PC visit and admission rates, ED diagnoses and consults ordered.
Results: 4329 (68% of eligible population) agreed to participate in the study. 1283 patients (30%) made 2349 ED visits in the year following diagnosis. 58% of patients made 1 visit, 42% made 2-12 visits. 13% of ED visits required an oncology consultation; 77% of these resulted in an admission. 691 patients (16%) made 1316 visits to a palliative care service (including consultation, inpatient, hospice or community). 58% of patients made 2-7 visits. People with lung cancer, older patients and patients reporting higher distress, anxiety, pain and fatigue had higher ED utilization.

Conclusion: Adult cancer patients have high ED presentation and revisit rates. These visits are characterized by high acuity presentations, with many resulting in a consult and admission. Collectively, these results indicate that adult cancer patients represent a significant burden on ED resources.