Eastern Maine Medical Center, Bangor, ME
Anannya Patwari , Vineel Bhatlapenumarthi , Courtnery Brann , Jackson Waldrip , Victoria Caruso , Adam Curtis , Catherine Chodkiewicz
Background: Reducing ED visits in patients with cancer is cost saving and is particularly relevant during the COVID pandemic. Methods: We analyzed the number of ED visits occurred in our breast cancer population between July 12019 and August 31 2020 including demographics, stage distribution, treatment type within the month of ED visit, reason, time of the day, day of the week the visit occurred. Results: A total of 101 patients had 162 visits. 38 (38%) had more than 1 ED visit. Majority (36%) had stage 4 disease at the time of ED visit. The top 5 reasons for ED visits were fall and injury (N=30), GI (N=24), cardiac (N=17), respiratory symptoms (N=14) and cancer related pain (N=11). The median age in patients with ED visit due to fall injury/pain was 75 and non-fall injury/pain was 55 years. The most common reasons for chemotherapy induced ED visits were GI related (N=8) and Neutropenic fever (N=7). Cyclophosphamide/doxorubicin was the common regimen associated with neutropenic fever. A total of 72 (44%) visits resulted in hospital admissions. Most common symptom categories requiring hospital admissions were cardiac (82.3%), sepsis/cellulitis (81.8%), respiratory (64%), cancer related pain (54.5%) and GI (50%). Most were on endocrine therapy at the time of their visit (N= 59) and 31 were on no treatment at all. Falls were unrelated to disease or treatment and occurred in patients above age 70. Visits occurred during working hours from 6AM to 5PM, with peak incidence on Mondays and Fridays. Conclusions: Reducing ED visit in cancer patients is a worthwhile endeavor particularly in the context of the COVID pandemic. The main reason for ED visits were falls and injuries that were unrelated to disease or treatment in breast cancer patients. As a result, we are implementing systematic physical therapy assessment for our breast cancer population over age of 60 at our cancer center and call us first campaign, to get an opportunity to intervene prior to going to the ED as majority of the ED visits occurred during working hours.
Symptom category | Specific symptom | Total ER visits | Chemo Induced | Cancer Induced | Non cancer induced | Hospital admissions |
---|---|---|---|---|---|---|
Fall/injury/pain | Back pain, joint pains, broken hip/wrist/arm/ribs | 30 | 0 | 0 | 30 | 4 |
Gastrointestinal (GI) | Vomiting/diarrhea/abdominal pain/GI bleed/Pancreatitis/Bowel obstruction | 24 | 8 | 4 | 12 | 12 |
Cardiac | Chest pain/afib/CHF*/ pericardial effusion/ MI**/ palpitations | 17 | 0 | 2 | 15 | 14 |
Respiratory | Pneumonia/dyspnea/PE***/ Pleural effusion/ | 14 | 0 | 1 | 13 | 9 |
Cancer related pain | cancer pain/ pain from ascites/ biliary obstruction | 11 | 0 | 11 | 0 | 6 |
Sepsis/cellulitis | Sepsis/cellulitis | 11 | 0 | 7 | 4 | 9 |
Genitourinary | UTI/Pyelonephritis | 9 | 1 | 1 | 7 | 5 |
Fever | Febrile neutropenia/fever | 7 | 6 | 0 | 1 | 4 |
Others | Weakness/dizziness/Allergic reactions/post procedural complications/psychiatry problems/others | 39 | 3 | 2 | 34 | 9 |
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Abstract Disclosures
2021 ASCO Quality Care Symposium
First Author: Anannya Patwari
2024 ASCO Annual Meeting
First Author: Tilak Tvsvgk
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