Palliative Care Needs and Clinical Outcomes of Patients with Advanced Cancer in the Emergency Department

摘要

Background: Older adults with cancer use the emergency department (ED) for acute concerns.Objectives: Characterize the palliative care needs and clinical outcomes of advanced cancer patients in the ED.Design: A planned secondary data analysis of the Comprehensive Oncologic Emergencies Research Network (CONCERN) data.Settings/Subjects: Cancer patients who presented to the 18 CONCERN affiliated EDs in the United States.Measurements: Survey included demographics, cancer type, functional status, symptom burden, palliative and hospice care enrollment, and advance directive code status.Results: Of the total (674/1075, 62.3%) patients had advanced cancer and most were White (78.6%) and female (50.3%); median age was 64 (interquartile range 54–71) years. A small proportion of them were receiving palliative (6.5% [95% confidence interval; CI 3.0–7.6]; p = 0.005) and hospice (1.3% [95% CI 1.0–3.2]; p = 0.52) care and had a higher 30-day mortality rate (8.3%, [95% CI 6.2–10.4]).Conclusions: Patients with advanced cancer continue to present to the ED despite recommendations for early delivery of palliative care.