Treatment-related events resulted in a low number of unplanned emergency department (ED) visits among patients with non-small cell lung cancer (NSCLC) receiving active treatment with either tyrosine kinase inhibitors (TKIs), immune checkpoint inhibitors (ICIs), or chemotherapy. In addition, a substantial portion of these unplanned visits were unnecessary or found to be preventable, according to the results of a retrospective study published in JCO Oncology Practice.1
“A better understanding of the main drivers of unplanned cancer care may lead to the development of evidence-based preventative strategies,” the study authors wrote. Therefore, the aim of this study was to evaluate the drivers of unplanned ED visits attributable to NSCLC treatment.
The retrospective study evaluated the electronic health records of 97 patients with NSCLC who received chemotherapy or TKI or ICI therapy at a single institution and visited the ED in 2018. Patients were identified using the Stanford Medicine Research Data Repository (STARR). The ED visits were assessed for the reason for the visit and whether the visit was preventable.
There were 173 ED visits, the majority of which were cancer-related (54%). Most of these visits involved patients in the TKI group (61%), followed by the ICI group (49%), and the chemotherapy group (42%).
Twenty-nine percent of the visits were determined to be “not directly related” to cancer or its treatment. Eight percent were visits initiated by an outpatient provider who sent the patient to the ED to rule out a medico-oncologic emergency.
The remaining 9% were deemed treatment-related. Two percent of these visits were seen in patients receiving TKIs; 12%, in those receiving ICIs; and 21%, in those receiving chemotherapy (P <.001).
Of all the ED visits, 24% were classified as “potentially preventable”; 10% were deemed unnecessary. This assessment was based on the finding that 52% of visits occurred during business hours, 53% were for complaints that began at least 2 days before presentation, and 48% led to workup that could have been performed in the outpatient setting. Fifty-five percent did not result in admission.
“These findings indicate that a significant portion of unplanned hospital care for patients with lung cancer might be managed with early intervention, extension of ambulatory care, and patient education on outpatient avenues of care,” the study authors concluded.
Shah MP, Neal JW. Relative impact of anticancer therapy on unplanned hospital care in patients with non–small-cell lung cancer. JCO Oncol Pract. Published online December 22, 2020. doi:10.1200/OP.20.00612