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Preventing emergency department visits among patients with cancer: a scoping review

  • Review Article
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Supportive Care in Cancer Aims and scope Submit manuscript

A Correction to this article was published on 24 June 2020

This article has been updated

Abstract

Purpose

The objective of this scoping review was to examine the effectiveness of supportive care interventions designed to reduce ED visits among patients receiving active cancer treatment.

Methods

Literature search involving nine electronic databases and grey literature. Inclusion criteria considered studies assessing the impact of any intervention to reduce ED utilization among patients with active cancer. Dichotomous and continuous outcomes were summarized as risk ratio (RR) or mean difference (MD) with 95% confidence intervals (CIs) using a random-effects model, wherever appropriate.

Results

A total of 25 studies were included. Interventions identified in these studies comprised the following: routine and symptom-based patient follow-up, oncology outpatient clinics, early symptom detection, comprehensive inpatient management, hospital at home, and patient navigators. Six out of eight studies assessing oncology outpatient clinics reported a decrease in the proportion of patients presenting to the ED. A meta-analysis of three of these studies did not demonstrate reduction in ED utilization (RR 0.78; 95% CI 0.56 to 1.08; I2 = 77%) when comparing oncology outpatient clinics with standard care; however, sensitivity analysis supported a decrease in ED visits (RR 0.86; 95% CI 0.74 to 0.99; I2 = 47%). Three studies assessing patient follow-up interventions showed no difference in ED utilization (RR 0.69; 95% CI 0.38 to 1.25; I2 = 86%).

Conclusion

A variety of supportive care interventions designed to mitigate ED presentations by patients receiving active cancer treatment have been developed and evaluated. Limited evidence suggests that an oncology outpatient clinic may be an effective strategy to reduce ED utilization; however, additional high-quality studies are needed.

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Change history

  • 24 June 2020

    Table 2 is incorrect in the original manuscript. The correct table 2 is shown below

References

  1. Gysels M, Higginson IJ, Rajasekaran M, Davies E, Harding R (2004) Improving supportive and palliative care for adults with cancer: research evidence. National Institute of Clinical Excellence & Kings College London, London

    Google Scholar 

  2. Harrison JD, Young JM, Price MA, Butow PN, Solomon MJ (2009) What are the unmet supportive care needs of people with cancer? A systematic review. Support Care Cancer 7:1117–1128

    Article  Google Scholar 

  3. Rivera DR, Gallicchio L, Brown J, Liu B, Kyriacou DN, Shelburne N (2017) Trends in adult cancer-related emergency department utilization: an analysis of data from the nationwide emergency department sample. JAMA Oncol 3:e172450

    Article  Google Scholar 

  4. Earle CC, Park ER, Lai B, Weeks JC, Ayanian JZ, Block S (2003) Identifying potential indicators of the quality of end-of-life cancer care from administrative data. J Clin Oncol 21:1133–1138

    Article  Google Scholar 

  5. DiMartino LD, Weiner BJ, Mayer DK, Jackson GL, Biddle AK (2014) Do palliative care interventions reduce emergency department visits among patients with cancer at the end of life? A systematic review. J Palliat Med 17:1384–1399

    Article  Google Scholar 

  6. Barbera L, Taylor C, Dudgeon D (2010) Why do patients with cancer visit the emergency department near the end of life? CMAJ 182:563–568

    Article  Google Scholar 

  7. Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D, Moher D, Peters MDJ, Horsley T, Weeks L, Hempel S, Akl EA, Chang C, McGowan J, Stewart L, Hartling L, Aldcroft A, Wilson MG, Garritty C, Lewin S, Godfrey CM, Macdonald MT, Langlois EV, Soares-Weiser K, Moriarty J, Clifford T, Tunçalp Ö, Straus SE (2018) PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med 169:467–473

    Article  Google Scholar 

  8. Efthimiou O (2018) Practical guide to the meta-analysis of rare events. Evid Based Ment Health 21:72–76

    Article  Google Scholar 

  9. Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions version 5.1.0 [updated March 2011]. The Cochrane Collaboration. www.cochrane-handbook.org

  10. Aibar J, Fernandez-Martinez A, Seijas N et al (2013) Hospital at home in cancer patients. Support Care Cancer 21:S21

  11. Colligan EM, Ewald E, Keating NL, Parashuram S, Spafford M, Ruiz S, Moiduddin A (2017) Two innovative cancer care programs have potential to reduce utilization and spending. Med Care 55:873–878

  12. Kim MY (2011) Effects of oncology clinical nurse specialists’ interventions on nursing-sensitive outcomes in South Korea. Clin J Oncol Nurs 15:E66–E74

  13. Siew PL, Bee Kuan LIM (2017) Nurse-led discharge care protocol: a randomised control trial. Singapore Nursing Journal 44:2–6

  14. Wang SM, Kung PT, Wang YH, Huang KH, Tsai WC (2014) Effects of multidisciplinary team care on utilization of emergency care for patients with lung cancer. Am J Manag Care 20:e353–e364

  15. Barbera L, Sutradhar R, Howell D, Sussman J, Seow H, Dudgeon D, Atzema C, Earle C, Husain A, Liu Y, Krzyzanowska MK (2015) Does routine symptom screening with ESAS decrease ED visits in breast cancer patients undergoing adjuvant chemotherapy? Support Care Cancer 23:3025–3032

  16. Basch E, Deal AM, Kris MG, Scher HI, Hudis CA, Sabbatini P, Rogak L, Bennett AV, Dueck AC, Atkinson TM, Chou JF, Dulko D, Sit L, Barz A, Novotny P, Fruscione M, Sloan JA, Schrag D (2016) Symptom monitoring with patient-reported outcomes during routine cancer treatment: a randomized controlled trial. J Clin Oncol 34:557–565

  17. Howell D, Li M, Rosberger Z, et al (2017) A person-centered e-proms multi-faceted intervention to improve patient experience and health outcomes: a multi-site implementation study in diverse ambulatory oncology practices. J Clin Oncol 35:182

  18. Siefert ML, Blonquist TM, Berry DL, Hong F (2015) Symptom-related emergency department visits and hospital admissions during ambulatory cancer treatment. JCSO 13:188–194

  19. Taarnhoej GA, Johansen C, Dohn LH, Lindberg H, Pappot H (2018) Patient-reported outcomes in bladder cancer; a multicenter randomized controlled trial-a study design. Eur Urol 17:e1144

  20. Bishop KD, Fenton MA, Szymanski T, Begnoche M (2014) Reduction of emergency department utilization via access to outpatient cancer care. J Clin Oncol 32:128

  21. Hoverman JR, Klein I, Harrison DW, Hayes JE, Garey JS, Harrell R, Sipala M, Houldin S, Jameson MD, Abdullahpour M, McQueen J, Nelson G, Verrilli DK, Neubauer M (2014) Opening the black box: the impact of an oncology management program consisting of level 1 pathways and an outbound nurse call system. J Oncol Pract 10:63–67

  22. Kurtz ME, Kurtz JC, Given CW, Given B (2006) Effects of a symptom control intervention on utilization of health care services among cancer patients. Med Sci Monit 12:R319–R324

  23. Lai XB, Ching SSY, Wong FKY, Leung CWY, Lee LH, Wong JSY, Lo YF (2018) The cost-effectiveness of a nurse-led care program for breast cancer patients undergoing outpatient-based chemotherapy-a feasibility trial. Eur J Oncol Nurs 36:16–25

  24. Martinez KA, Friese C, Kershaw T, Given CW, Fendrick M, Northouse L (2015) Effect of a nurse-led psychoeducational intervention on healthcare service utilization among adults with advanced cancer. Oncol Nurs Forum 42:E310–E318

  25. Salmany SS, Ratrout L, Amireh A, Agha R, Nassar N, Mahmoud N, Rimawi D, Nazer L (2018) The impact of pharmacist telephone calls after discharge on satisfaction of oncology patients: a randomized controlled study. J Oncol Pharm Pract 24:359–364

    Article  Google Scholar 

  26. Shaw JM, Young JM, Butow PN, Badgery-Parker T, Durcinoska I, Harrison JD, Davidson PM, Martin D, Sandroussi C, Hollands M, Joseph D, Das A, Lam V, Johnston E, Solomon MJ (2016) Improving psychosocial outcomes for caregivers of people with poor prognosis gastrointestinal cancers: a randomized controlled trial (Family Connect). Support Care Cancer 24:585–595

  27. Suzuki S, Enokida T, Kobayashi T et al (2014) Evaluation of the impact of a flowchart-type leaflet for cancer inpatients. SAGE Open Medicine 2:2050312114531256

  28. Antonuzzo A, Vasile E, Sbrana A, Lucchesi M, Galli L, Brunetti IM, Musettini G, Farnesi A, Biasco E, Virgili N, Falcone A, Ricci S (2017) Impact of a supportive care service for cancer outpatients: management and reduction of hospitalizations. Preliminary results of an integrated model of care. Support Care Cancer 25:209–212

  29. Burdett N, Hong H, Roberts S, Adams J, Hocking C, Joshi R (2016) Avoiding the emergency department: a rapid assessment and supportive care clinic in a busy Australian cancer center. Asia-Pac J Clin Oncol 12:150

  30. Diyar R, Cheung A, Littler D et al (2018) The impact of an accelerated pathway for assessing jaundiced hepato-pancreato-biliary (HPB) cancer patients. Gut 67:A235

  31. Harr B, Hamker J, Joshi NP, Ward MC, Bodmann J, Ives D, Rahe M, Nwizu T, Adelstein DJ, Greskovich JF Jr, Koyfman S (2015) Advanced practice nurse, follow-up clinic reduces emergency room visits and admissions in high-risk patients after chemoradiation therapy for head and neck cancer. Int J Radiat Oncol Biol Phys 93:E468

  32. Sivendran S, Holliday R, Guittar R, Cox C, Newport K (2016) The impact of a nurse practitioner-led symptom clinic on emergency department use in cancer patients. JCSO 14:268–272

  33. Terzo L, Fleming M, Yechoor A, Camporeale J, Troxler M, Roth E, Tan X, Pignone M, Marks L, Chera B (2017) Reducing unplanned admissions: focusing on hospital admissions and emergency department visits for patients with head and neck cancer during radiation therapy. Clin J Oncol Nurs 21:363–369

    Article  Google Scholar 

  34. Waters TM, Kaplan CM, Graetz I, Price MM, Stevens LA, McAneny BL (2019) Patient-centered medical homes in community oncology practices: changes in spending and care quality associated with the COME HOME experience. J Oncol Pract 15:e56–e64

    Article  Google Scholar 

  35. Handley NR, Bekelman JE (2019) The oncology hospital at home. J Clin Oncol 37:448–452

    Article  Google Scholar 

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Acknowledgments

The authors would like to thank Dr. Water for responding to our requests for additional information.

Funding

Funding for this review was provided by the Cancer Strategic Clinical Network of Alberta Health Services (AHS). Dr. Rowe’s research is supported by the Canadian Institutes of Health Research (CIHR) as the Scientific Director of the Institute of Circulatory and Respiratory Health (ICRH) through the Government of Canada (Ottawa, ON).

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Authors and Affiliations

  1. Department of Emergency Medicine, Faculty of Medicine & Dentistry, University of Alberta, 1G1.43 WMC 8440-112 Street NW, Edmonton, AB, T6G 2B7, Canada

    Scott W. Kirkland, Miriam Garrido-Clua, Daniela R. Junqueira & Brian H. Rowe

  2. J.W. Scott Health Sciences Library, University of Alberta, 2K3.28 Walter C. Mackenzie Health Sciences Centre 8440-112 Street NW, Edmonton, AB, T6G 2R7, Canada

    Sandra Campbell

  3. School of Public Health, University of Alberta, Edmonton, AB, Canada

    Brian H. Rowe

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Contributions

Scott Kirkland and Miriam Garrido Clua contributed to the conception and design of the review, study screening, acquisition of data, data analysis and interpretation, and manuscript preparation. Daniela Junqueira contributed to the design of the review, acquisition of data, data analysis and interpretation, and manuscript preparation. Sandra Campbell contributed to the development of the electronic search and manuscript preparation. Brian Rowe is the guarantor of the review. He contributed to securing funding, the conception and design of the review, study adjudication, data analysis of interpretation, and manuscript preparation.

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Correspondence to Brian H. Rowe.

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The authors declare that they have no conflict of interest.

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The funding organizations had no involvement in any aspect of the conduct, analysis, and manuscript preparation of this study; the funders take no responsibility for the results of this review.

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Search strings for the electronic search (PDF 270 kb)

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Bubble graphic of the frequency of specific interventions evaluated among included studies (n = 25) (PNG 396 kb)

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Kirkland, S.W., Garrido-Clua, M., Junqueira, D.R. et al. Preventing emergency department visits among patients with cancer: a scoping review. Support Care Cancer 28, 4077–4094 (2020). https://doi.org/10.1007/s00520-020-05490-1

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