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Cancer pain management in the emergency department: a multicenter prospective observational trial of the Comprehensive Oncologic Emergencies Research Network (CONCERN)

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Abstract

Purpose

Many patients with cancer seek care for pain in the emergency department (ED). Prospective research on cancer pain in this setting has historically been insufficient. We conducted this study to describe the reported pain among cancer patients presenting to the ED, how pain is managed, and how pain may be associated with clinical outcomes.

Methods

We conducted a multicenter cohort study on adult patients with active cancer presenting to 18 EDs in the USA. We reported pain scores, response to medication, and analgesic utilization. We estimated the associations between pain severity, medication utilization, and the following outcomes: 30-day mortality, 30-day hospital readmission, and ED disposition.

Results

The study population included 1075 participants. Those who received an opioid in the ED were more likely to be admitted to the hospital and were more likely to be readmitted within 30 days (OR 1.4 (95% CI: 1.11, 1.88) and OR 1.56 (95% CI: 1.17, 2.07)), respectively. Severe pain at ED presentation was associated with increased 30-day mortality (OR 2.30, 95% CI: 1.05, 5.02), though this risk was attenuated when adjusting for clinical factors (most notably functional status).

Conclusions

Patients with severe pain had a higher risk of mortality, which was attenuated when correcting for clinical characteristics. Those patients who required opioid analgesics in the ED were more likely to require admission and were more at risk of 30-day hospital readmission. Future efforts should focus on these at-risk groups, who may benefit from additional services including palliative care, hospice, or home-health services.

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Acknowledgments

The Comprehensive Oncologic Emergencies Research Network (CONCERN) Network supported this study with scientific review and suggestions on the study design and conduct. Additional information about CONCERN is available at https://epi.grants.cancer.gov/concern/. Nonniekaye Shelburne, MS, CRNP, AOCN, and the Epidemiology and Genomics Research Program within the National Cancer Institute’s Division of Cancer Control and Population Science, Bethesda, Maryland, assisted with study design, data management, and ongoing support of the research network. We thank the study participants, research staff, and medical centers who have provided data for this study.

Author information

Authors and Affiliations

  1. Department of Emergency Medicine, University of California San Diego, 200 W. Arbor Dr. #8676, San Diego, CA, 92103, USA

    Christopher J. Coyne

  2. Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Cielito C. Reyes-Gibby

  3. The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Danielle D. Durham

  4. Department of Emergency Medicine, University of Rochester, Rochester, NY, USA

    Beau Abar & David Adler

  5. Department of Emergency Medicine, William Beaumont Hospital – Troy Campus, Troy, MI, USA

    Aveh Bastani

  6. Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA

    Steven L. Bernstein

  7. Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, MA, USA

    Christopher W. Baugh & Daniel J. Pallin

  8. Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA

    Jason J. Bischof

  9. Ronald O. Perelman Department of Emergency Medicine and Population Health, New York University School of Medicine, New York, NY, USA

    Corita R. Grudzen

  10. Department of Emergency Medicine, University of Washington, Seattle, WA, USA

    Daniel J. Henning

  11. Greenville Health System Cancer Institute, Greenville, SC, USA

    Matthew F. Hudson

  12. Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Adam Klotz

  13. Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center and the Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA

    Gary H. Lyman

  14. Division of Emergency Medicine, University of Utah, Salt Lake City, UT, USA

    Troy E. Madsen

  15. Department of Pediatrics, University of South Florida Morsani College of Medicine, Tampa, FL, USA

    Juan Felipe Rico

  16. Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH, USA

    Richard J. Ryan

  17. Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA

    Nathan I. Shapiro

  18. Department of Emergency Medicine, William Beaumont Hospital, Royal Oak, MI, USA

    Robert Swor

  19. Department of Radiation Medicine, Knight Cancer Institute, Oregon Health & Sciences University, Portland, OR, USA

    Charles R. Thomas Jr.

  20. Department of Emergency Medicine, Allegheny Health Network, Pittsburgh, PA, USA

    Arvind Venkat

  21. Department of Emergency Medicine, University of South Florida Morsani College of Medicine, Tampa, FL, USA

    Jason Wilson

  22. Department of Emergency Medicine and Department of Endocrine Neoplasia & Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Sai-Ching Jim Yeung

  23. Departments of Emergency Medicine and Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA

    Jeffrey M. Caterino

Authors
  1. Christopher J. Coyne
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  2. Cielito C. Reyes-Gibby
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  3. Danielle D. Durham
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  4. Beau Abar
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  5. David Adler
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  6. Aveh Bastani
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  7. Steven L. Bernstein
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  8. Christopher W. Baugh
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  9. Jason J. Bischof
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  10. Corita R. Grudzen
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  11. Daniel J. Henning
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  12. Matthew F. Hudson
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  13. Adam Klotz
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  14. Gary H. Lyman
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  15. Troy E. Madsen
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  16. Daniel J. Pallin
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  17. Juan Felipe Rico
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  18. Richard J. Ryan
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  19. Nathan I. Shapiro
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  20. Robert Swor
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  21. Charles R. Thomas Jr.
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  22. Arvind Venkat
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  23. Jason Wilson
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  24. Sai-Ching Jim Yeung
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  25. Jeffrey M. Caterino
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Corresponding author

Correspondence to Christopher J. Coyne.

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Conflict of interest

Dr. Baugh has worked as a consultant and advisory board member for Janssen Pharmaceuticals, Nabriva Therapeutics, Salix Pharmaceuticals, and Vapotherm; has previously received research funding from Janssen Pharmaceuticals and Boehringer Ingelheim; and has served as an advisory board member and as a paid speaker for Roche Diagnostics. Dr. Yeung is the principal investigator of an investigator-initiated clinical trial supported by DepoMed and a retrospective clinical study supported by Bristol-Myers Squibb through ARISTA-USA (BMS/Pfizer American Thrombosis Investigator Initiated Research Program). Dr. Yeung participated in an advisory panel for Celgene. Dr. Henning receives research support from Baxter and provides consulting services to CytoVale.

Ethics approval

This study was approved by all participating institutional review boards.

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All patients provided written consent and signed a HIPPA waiver prior to participation.

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Coyne, C.J., Reyes-Gibby, C.C., Durham, D.D. et al. Cancer pain management in the emergency department: a multicenter prospective observational trial of the Comprehensive Oncologic Emergencies Research Network (CONCERN). Support Care Cancer 29, 4543–4553 (2021). https://doi.org/10.1007/s00520-021-05987-3

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