Over Half of ED Visits From Cancer Patients Could Be Prevented

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More than half of emergency department (ED) visits from US patients with cancer are potentially preventable, a new analysis suggests.

Overall, researchers found that 18.3 million (52%) ED visits among patients with cancer between 2012 and 2019 were potentially avoidable. Pain was the most common reason for such a visit. Notably, the number of potentially preventable ED visits documented each year increased over the study period.

“These findings highlight the need for cancer care programs to implement evidence-based interventions to better manage cancer treatment complications, such as uncontrolled pain, in outpatient and ambulatory settings,” say the authors, led by Amir Alishahi Tabriz, MD, PhD, MPH, Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida.

Authors of an accompanying editorial agree, noting that “patients at risk for having uncontrolled pain could potentially be identified earlier, and steps could be taken that would address their pain and help prevent acute care visits.”

The study and the editorial were published online January 19 in JAMA Network Open.

Patients with cancer experience a range of side effects from their cancer and treatment. Many such problems can be managed in the ambulatory setting but are often managed in the ED, which is far from optimal for patients with cancer from both a complications and cost perspective. Still, little is known about whether ED visits among patients with cancer are avoidable.

To better understand unnecessary emergency care use by these patients, Tabriz and colleagues evaluated trends and characteristics of potentially preventable ED visits among adults with cancer who had an ED visit between 2012 and 2019. The authors used the Centers for Medicare & Medicaid Services definition for a potentially preventable ED visit among patients receiving chemotherapy.

Among the 35.5 million ED visits made by patients with cancer during the study period, 18.3 million (52%) were identified as potentially preventable. Nearly 5.8 million of these visits (21%) were classified as being of “high acuity,” and almost 30% resulted in unplanned hospitalizations.

Pain was the most common reason for potentially preventable ED visits, accounting for 37% of these visits.

The absolute number of potentially preventable ED visits among cancer patients increased from about 1.8 million in 2012 to 3.2 million in 2019. The number of patients who visited the ED because of pain more than doubled, from roughly 1.2 million in 2012 to 2.4 million in 2019.

“The disproportionate increase in the number of ED visits by patients with cancer has put a substantial burden on EDs that are already operating at peak capacity” and “reinforces the need for cancer care programs to devise innovative ways to manage complications associated with cancer treatment in the outpatient and ambulatory settings,” Tabriz and co-authors explain.

The increase could be an “unintended” consequence of efforts to decrease overall opioid administration in response to the opioid epidemic, Tabriz and colleagues note. For example, the authors point to a recent study that found that about half of patients with cancer who had severe pain did not receive outpatient opioids in the week before visiting the ED.

“Even access to outpatient care does not mean patients can get the care they need outside an ED,” write editorialists Erek Majka, MD, with Summerlin Hospital, Las Vegas, Nevada, and N. Seth Trueger, MD, MPH, with Northwestern University, Chicago. Thus, “it is no surprise that patients are sent to the ED if the alternatives do not have the staff or diagnostic and therapeutic capabilities the patients need.”

Overall, however, the “goal is not to eliminate ED visits for their own sake; rather, the goal is better care of patients with cancer, and secondarily, in a manner that is cost-effective,” Majka and Trueger explain.

No specific funding for the study was reported. The authors have disclosed no relevant financial relationships. Trueger is digital media editor of JAMA Network Open, but he was not involved in decisions regarding review of the manuscript or its acceptance.

JAMA Netw Open. Published January 19, 2023. Full text, Editorial

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