Study: EDs Need Better Strategies for Cancer Care

11/06/17

A recent study calls for new standards for hospital ED staff to manage certain conditions for older patients with cancer in observation status, and to reserve hospital resources for other patients, published in JNCCN (October 2017;15:1234-1239).

Hospital usage of observation status for patients with cancer who check in to the ED is in need of further research. Moreover, observation status may be a viable alternative to inpatient admission for patients with cancer and certain conditions.

Allison Lipitz-Snyderman, PhD, assistant attending outcomes research scientist, Memorial Sloan Kettering Cancer Center (New York, NY), and colleagues conducted a study to assess the use of observation status among Medicare beneficiaries with and without cancer. Researchers used population-based SEER-Medicare data to assess differences in the use of observation status between patients aged at least 66 years with cancer (n = 151,193) and without cancer using a matched cohort. Those with cancer had a diagnosis of breast, colon, lung, or prostate cancer between 2006 and 2008.

After adjusting for patient characteristics and the volume of hospitalizations, researchers found that observation status is used less frequently among beneficiaries with cancer than those without cancer (43 vs 69 observation status visits per 1000 inpatient admissions, respectively). This estimated observation rate per 1000 inpatient admissions applied particularly to beneficiaries aged less than 75 years, those with a Charlson comorbidity index of 0, and those without a prior hospitalization.

Additionally, researchers noted that patients diagnosed with breast and prostate cancers had the higher adjusted and unadjusted observation rates per 1000 inpatient admissions, compared with those diagnosed with colon and lung cancers.

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Researchers concluded that observation status is used significantly less for older patients with cancer. “There may be opportunities to develop standards for ED staff to manage certain conditions for patients with cancer in observation status, and to reserve hospital resources for those who need it most,” they wrote.

"By implementing a set of standards and treatment protocols for addressing specific clinical conditions, we can increase the systematic use of observation status for patients with cancer," said one of the researchers involved in the study (October 24, 2017). "Some examples include the management of pain, nausea, vomiting, diarrhea, constipation, cellulitis, hypercalcemia, and steroid related hyperglycemia.”—Zachary Bessette