Analysis of reasons for emergency department (ED) visits and resulting hospital admissions in breast cancer patients: A retrospective study from rural cancer center in Maine.

Authors

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Anannya Patwari

Eastern Maine Medical Center, Bangor, ME

Anannya Patwari , Vineel Bhatlapenumarthi , Courtnery Brann , Jackson Waldrip , Victoria Caruso , Adam Curtis , Catherine Chodkiewicz

Organizations

Eastern Maine Medical Center, Bangor, ME, University of New England College of Osteopathic Medicine, Biddeford, ME, Lafayette Cancer Ctr, Brewer, ME

Research Funding

No funding received
None

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 Details

Meeting

2021 ASCO Annual Meeting

Session Type

Publication Only

Session Title

Publication Only: Health Services Research and Quality Improvement

Track

Quality Care/Health Services Research

Sub Track

Quality Improvement

Citation

J Clin Oncol 39, 2021 (suppl 15; abstr e18682)

DOI

10.1200/JCO.2021.39.15_suppl.e18682

Abstract #

e18682

Abstract Disclosures