R09Emergencies in cancer patients: data on 15,623 cases from a large volume single centre from 2001 to 2013

Background: Cancer patients (pts) present often with acute syndromes requiring an urgent management. This scenario has dramatically changed during the last years due to the higher prevalence of cancer pts on active treatment, and specific drug–related safety issues. The aim of this study was to determine the main clinical characteristics, relevant needs and possible outcomes in the population of cancer pts admitted to our Emergency Department (ED). Methods: We performed a retrospective cohort study on 15,623 pts out of 1,101,259 adult pts (1.42%) admitted to our ED between January 2001 and December 2013 for cancer-related problems. Demographics, clinical findings and hospitalization rate were gathered from the administrative sources of the local database. Results: Mean age was 65.1± 14.8, women prevalence slightly higher. The majority of visits occurred during normal hours (77.6%) and working days (74.4%). Pts not requiring a urgent treatment, according to triage assessment, were 60.4%. Only 14.7% of pts were referred to ED by another physician (GPs, surgeon, medical oncologist). For 63.2% it was a self-decision and was not specified for the remaining group. The chief complaints were fever 21.5%, pain 27.7%, asthenia 13.6%, dyspnea 13.1%, gastrointestinal (vomiting 15.3%, diarrhea 2.7%), hematologic (anemia 4.3%, neutropenia 1.9%, thrombocytopenia 0.5%). Complaints related, or possibly related, to an active antitumor treatment, i.e. chemotherapy and/or radiation therapy, are under evaluation and will be outlined at the meeting. Pts receiving an active treatment were 21.9%. The most common cancer sites were gastrointestinal (30.5%), lung (20.1%), ovarian (8.53%), breast (8.17%). Pts with metastatic disease were 21.2%. Hospitalization rate was 73.7%. Pts discharge due to symptoms improvement was 19.3%. Mortality at the ED was 0.9%. Hospitalization was refused by 3.7% of pts. Conclusions: A better understanding of emergency care needs for cancer pts is crucial for implementing the quality of care and optimizing the resources of the healthcare system. Further analyses and prospective studies are warranted to define possible outcomes and algorithms for the most appropriate treatments of cancer-related problems.