Increased cancer incidence and improved survival rates evidence that more oncological patients are seeking emergency care. Oncological patients require complex supportive and palliative care, and are likely to visit the ER several times [1]. The main difference between a general ER and a dedicated acute cancer or OEM department is the type of care provided. A general ER offers treatment for a wide range of medical conditions and emergencies, while a dedicated OEM specializes in providing comprehensive care as well as supportive services.
According to Obermeyer et al (2016) [2], 81% of patients with cancer seek the ER in the last 6 months of life. A hospital's ER provides urgent medical care to patients suffering from sudden, unexpected medical complications. Although it is usual for the ER to be staffed by emergency medical personnel, clinicians seem to lack oncology-specific expertise and the skills necessary to effectively manage symptoms in patients with this complex oncology condition3. Therefore, they do not always receive the recommended treatment for adequate pain relief such as pain management, nutritional counseling, and psychological support.
Studies suggest that 4% of all general ER visits are cancer-related and about two thirds of these visits result in hospitalization; a rate four times higher than the general population [1, 3, 4]. Clinical experience indicates that many of these admissions might be preventable, decreasing the risk of hospital acquired infections, deep vein thrombosis and falls that outweighs the benefit of inpatient clinical management [5]. A study from the UK found that metastatic cancer patient's hospitalizations are often associated with poor coordination of care and fragmented patient care pathways [6]. It is necessary to develop solutions to minimize the time oncology patients spend in the ER, while giving them access to specialized oncology management and supportive care [2].
Studies have found that a high proportion of oncology patients visiting the ER complain of pain [4, 7]. According to Tabriz et al (2023) [8] patients with cancer who visited the ER for pain accounted for 36.9% of visits, and the number of patients who visited ER for pain increased by 101.8% from 2012 to 2019. While these patients may have access to analgesics at home, acute symptoms may require immediate increased dosing, opioid rotation or other changes in medication, demanding a visit to the ER. The management of pain in oncology patients can have a significant impact on their quality of life, and it is therefore imperative that physicians receive dedicated pain management training.
There is limited data regarding pain-related emergency department visits in metastatic cancer patients. Sheba Medical Center has an OEM located in the Cancer Center, providing easy access for patients during business days. The hospital's main ER lacks trained oncology staff or specialists who can provide the necessary care for this complex population. Although the oncology staff in the OEM have not undertaken a specialty in Emergency Medicine, they deal with emergency care on a daily basis, and specialize in treating this complex population in terms of managing treatment toxicities, pain and symptoms and providing supportive care.
Based on these data, the objectives of this study were to compare hospitalization rates, opioid administration rates, supportive care consultation rates, hospice referral rates and 30-day all-cause mortality in metastatic cancer patients with abdominal pain-related complaints admitted to the ER and OEM at Sheba Medical Center.