Characterization of older adults with cancer seeking acute emergency department care: A prospective observational study Journal Article


Authors: Bischof, J. J.; Elsaid, M. I.; Bridges, J. F. P.; Rosko, A. E.; Presley, C. J.; Abar, B.; Adler, D.; Bastani, A.; Baugh, C. W.; Bernstein, S. L.; Coyne, C. J.; Durham, D. D.; Grudzen, C. R.; Henning, D. J.; Hudson, M. F.; Klotz, A.; Lyman, G. H.; Madsen, T. E.; Reyes-Gibby, C. C.; Rico, J. F.; Ryan, R. J.; Shapiro, N. I.; Swor, R.; Thomas, C. R.; Venkat, A.; Wilson, J.; Yeung, S. C. J.; Yilmaz, S.; Caterino, J. M.
Article Title: Characterization of older adults with cancer seeking acute emergency department care: A prospective observational study
Abstract: Introduction: Disparities in care of older adults in cancer treatment trials and emergency department (ED) use exist. This report provides a baseline description of older adults ≥65 years old who present to the ED with active cancer. Materials and methods: Planned secondary analysis of the Comprehensive Oncologic Emergencies Research Network observational ED cohort study sponsored by the National Cancer Institute. Of 1564 eligible adults with active cancer, 1075 patients were prospectively enrolled, of which 505 were ≥ 65 years old. We recruited this convenience sample from eighteen participating sites across the United States between February 1, 2016 and January 30, 2017. Results: Compared to cancer patients younger than 65 years of age, older adults were more likely to be transported to the ED by emergency medical services, have a higher Charlson Comorbidity Index score, and be admitted despite no significant difference in acuity as measured by the Emergency Severity Index. Despite the higher admission rate, no significant difference was noted in hospitalization length of stay, 30-day mortality, ED revisit or hospital admission within 30 days after the index visit. Three of the top five ED diagnoses for older adults were symptom-related (fever of other and unknown origin, abdominal and pelvic pain, and pain in throat and chest). Despite this, older adults were less likely to report symptoms and less likely to receive symptomatic treatment for pain and nausea than the younger comparison group. Both younger and older adults reported a higher symptom burden on the patient reported Condensed Memorial Symptom Assessment Scale than to ED providers. When treating suspected infection, no differences were noted in regard to administration of antibiotics in the ED, admissions, or length of stay ≤2 days for those receiving ED antibiotics. Discussion: We identified several differences between older (≥65 years old) and younger adults with active cancer seeking emergency care. Older adults frequently presented for symptom-related diagnoses but received fewer symptomatic interventions in the ED suggesting that important opportunities to improve the care of older adults with cancer in the ED exist. © 2022 Elsevier Ltd
Keywords: adult; aged; antibiotic agent; major clinical study; united states; cancer patient; prospective study; prospective studies; neoplasm; neoplasms; pain; cohort studies; nausea; cohort analysis; age; abdominal pain; emergency ward; length of stay; emergency service, hospital; antiinfective agent; anti-bacterial agents; thorax pain; emergency care; hospital admission; cancer epidemiology; geriatric patient; emergency health service; sore throat; hospital mortality; pyrexia idiopathica; help seeking behavior; acute care; emergency department; charlson comorbidity index; humans; human; male; female; article; pelvic pain; emergency service; hospital emergency service; neoplasm complications; neoplasm epidemiology; older patients with cancer; unscheduled care
Journal Title: Journal of Geriatric Oncology
Volume: 13
Issue: 7
ISSN: 1879-4068
Publisher: Elsevier Inc.  
Date Published: 2022-09-01
Start Page: 943
End Page: 951
Language: English
DOI: 10.1016/j.jgo.2022.06.003
PUBMED: 35718667
PROVIDER: scopus
PMCID: PMC11137847
DOI/URL:
Notes: Article -- Export Date: 3 October 2022 -- Source: Scopus
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  1. Adam Klotz
    22 Klotz