Many cancer patients are seeking emergency care for conditions that could be prevented by better management of cancer treatment complications, according to a study published in JAMA Network Open.
Researchers analyzed 35.5 million emergency department (ED) visits made by cancer patients and found that 51.6% of these visits were potentially preventable. The number of potentially preventable visits increased from 1.8 million in 2012 to 3.2 million in 2019.
To quantify potentially preventable visits, the researchers looked at trends and characteristics of ED visits from the National Hospital Ambulatory Medical Care Survey from January 2012 to December 2019.
In that time, there were a total of 854,911,106 ED visits, and 35,510,014 visits (4.2%) were made by patients with cancer. The percentage of ED visits among patients with cancer increased by 67.1% from 2012 to 2019 (P <.001 for trend).
More than 18 million (51.6%) of the cancer patients’ ED visits were identified as potentially preventable based on the Centers for Medicare and Medicaid Services (CMS) definition. The CMS defines an ED visit as potentially preventable if the primary diagnosis for the visit is 1 of 10 conditions.
The most common potentially preventable condition seen in the cancer patients was pain (36.9%), followed by fever (3.5%), nausea (3.5%), emesis (2.3%), pneumonia (1.7%), diarrhea (1.3%), dehydration (1.0%), anemia (0.7%), and sepsis (0.6%). Data on the remaining condition, neutropenia, were not included.
For most of these conditions, there was an increase in ED visits over the study period. The greatest increases were seen for dehydration (189.7%) and pain (101.8%). Decreases were seen for emesis (-33.7%) and pneumonia (-4.1%).
Overall, the percentage of potentially preventable ED visits among cancer patients increased slightly from 49.6% in 2012 to 51.5% in 2019 (P =.11). The absolute number of potentially preventable ED visits increased by 73.6% (P <.001 for trend).
Unplanned hospitalizations occurred for 28.9% of the cancer patients’ ED visits and 30.2% of the potentially preventable visits.
“In this cross-sectional study…, the number of potentially preventable ED visits increased over time, which may be explained by poorly managed symptoms, such as uncontrolled pain,” the researchers wrote. “These findings reinforce the need for cancer care programs to implement evidence-based interventions to better manage cancer treatment complications, such as pain, in outpatient and ambulatory settings.”
Tabriz AA, Turner K, Hong Y-R, et al. Trends and characteristics of potentially preventable emergency department visits among patients with cancer in the US. JAMA Netw Open. Published online January 19, 2023. doi:10.1001/jamanetworkopen.2022.50423