Skip to main content

Advertisement

SpringerLink
Log in

The Value Proposition of Observation Medicine in Managing Acute Oncologic Pain

  • Palliative Medicine (A Jatoi, Section Editor)
  • Published:
Current Oncology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Despite recommended best practice guidelines, pain remains an ongoing but undertreated symptom in patients with cancer, many of whom require emergency department evaluation for acute oncologic pain. A significant proportion of these patients are hospitalized for pain management, which increases healthcare costs and exposes patients to the risks of hospitalization. We reviewed the literature on observation medicine: an emerging mode of healthcare delivery which can offer patients with acute pain access to a hospital’s pain management solutions and specialists without an inpatient hospitalization. Specifically, we appraised the role of observation medicine in acute pain management and its financial implications in order to consider its potential impact on the management of acute oncologic pain.

Recent Findings

Recent evidence shows that observation medicine has the potential to decrease short-stay hospitalizations in cancer patients presenting with various concerns, including pain.

Summary

Observation medicine is reported to be successful in providing comprehensive and cost-effective care for non-cancer patients with acute pain, making it a promising alternative to short-stay hospitalizations for cancer patients with acute oncologic pain.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Dorrepaal KL, Aaronson NK, van Dam FS. Pain experience and pain management among hospitalized cancer patients. A clinical study. Cancer. 1989;63(3):593–8. https://doi.org/10.1002/1097-0142(19890201)63:33.0.co;2-5.

    Article  CAS  PubMed  Google Scholar 

  2. Neufeld NJ, Elnahal SM, Alvarez RH. Cancer pain: a review of epidemiology, clinical quality and value impact. Future Oncol. 2017;13(9):833–41. https://doi.org/10.2217/fon-2016-0423.

    Article  CAS  PubMed  Google Scholar 

  3. ••Coyne CJ, Reyes-Gibby C, Durham DD, Abar B, Adler D, Bastani A, 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. 2021;29(8):4543–4553. https://doi.org/10.1007/s00520-021-05987-3. (This 2021 study is the most recent study to redemonstrate the ongoing problem of oligoanalgesia in the care patients with acute oncologic pain.)

  4. Cohen E, Botti M, Hanna B, Leach S, Boyd S, Robbins J. Pain beliefs and pain management of oncology patients. Cancer Nurs. 2008;31(2):E1–8. https://doi.org/10.1097/01.NCC.0000305693.67131.7d.

    Article  PubMed  Google Scholar 

  5. Swanwick M, Haworth M, Lennard RF. The prevalence of episodic pain in cancer: a survey of hospice patients on admission. Palliat Med. 2001;15(1):9–18. https://doi.org/10.1191/026921601668030190.

    Article  CAS  PubMed  Google Scholar 

  6. Apolone G, Corli O, Caraceni A, Negri E, Deandrea S, Montanari M, et al. Pattern and quality of care of cancer pain management. Results from the Cancer Pain Outcome Research Study Group. Br J Cancer. 2009;100(10):1566–1574. https://doi.org/10.1038/sj.bjc.6605053.

  7. Dy SM, Asch SM, Naeim A, Sanati H, Walling A, Lorenz KA. Evidence-based standards for cancer pain management. J Clin Oncol. 2008;26(23):3879–85. https://doi.org/10.1200/JCO.2007.15.9517.

    Article  PubMed  Google Scholar 

  8. Cleary JF. Cancer pain management. Cancer Control. 2000;7(2):120–31. https://doi.org/10.1177/107327480000700202.

    Article  CAS  PubMed  Google Scholar 

  9. Hughes JA, Brown NJ, Chiu J, Allwood B, Chu K. The relationship between time to analgesic administration and emergency department length of stay: a retrospective review. J Adv Nurs. 2020;76(1):183–90. https://doi.org/10.1111/jan.14216.

    Article  PubMed  Google Scholar 

  10. Sokoloff C, Daoust R, Paquet J, Chauny J. Is adequate pain relief and time to analgesia associated with emergency department length of stay? A retrospective study. BMJ Open. 2014;4(3):e004288. https://doi.org/10.1136/bmjopen-2013-004288.

  11. Russell PB, Aveyard SC, Oxenham DR. An assessment of methods used to evaluate the adequacy of cancer pain management. J Pain Symptom Manage. 2006;32(6):581–8. https://doi.org/10.1016/j.jpainsymman.2006.05.024.

    Article  PubMed  Google Scholar 

  12. Chi N, Demiris G, Pike KC, Washington K, Oliver DP. Pain management concerns from the hospice family caregivers’ perspective. Am J Hosp Palliat Care. 2018;35(4):601–11. https://doi.org/10.1177/1049909117729477.

    Article  PubMed  Google Scholar 

  13. Nersesyan H, Konstantin VS. Current approach to cancer pain management: availability and implications of different treatment options. Ther Clin Risk Manag. 2007;3(3):381.

    CAS  PubMed  PubMed Central  Google Scholar 

  14. Von Roehn JH, Cleeland CS, Gonin R, Hatfield AK, Pandya KJ. Physician attitudes and practice in cancer pain management: a survey from the Eastern Cooperative Oncology Group. Ann Intern Med. 1993;119(2):121–6. https://doi.org/10.7326/0003-4819-119-2-199307150-00005.

    Article  Google Scholar 

  15. Abdolrazaghnejad A, Banaie M, Tavakoli N, Safdari M, Rajabpour-Sanati A. Pain management in the emergency department: a review article on options and methods. Adv J Emerg Med. 2018;2(4):e45. https://doi.org/10.22114/AJEM.v0i0.93.

  16. Gleber R, Vilke GM, Castillo EM, Brennan J, Oyama L, Coyne CJ. Trends in emergency physician opioid prescribing practices during the United States opioid crisis. Am J Emerg Med. 2020;38(4):735–40. https://doi.org/10.1016/j.ajem.2019.06.011.

    Article  PubMed  Google Scholar 

  17. Haider A, Zhukovsky DS, Meng YC, Baidoo J, Tanco KC, Stewart HA, et al. Opioid prescription trends among patients with cancer referred to outpatient palliative care over a 6-year period. J Oncol Pract. 2017;13(12):e972–e981. https://doi.org/10.1200/JOP.2017.024901.

  18. Makhlouf SM, Pini S, Ahmed S, Bennett MI. Managing pain in people with cancer—a systematic review of the attitudes and knowledge of professionals, patients, caregivers and public. J Cancer Educ. 2020;35(2):214–40. https://doi.org/10.1007/s13187-019-01548-9.

    Article  PubMed  Google Scholar 

  19. Sabbatini AK, Wright B, Hall MK, Basu A. The cost of observation care for commercially insured patients visiting the emergency department. Am J Emerg Med. 2018;36(9):1591–6. https://doi.org/10.1016/j.ajem.2018.01.040.

    Article  PubMed  Google Scholar 

  20. Ross MA, Hockenberry JM, Mutter R, Barrett M, Wheatley M, Pitts SR. Protocol-driven emergency department observation units offer savings, shorter stays, and reduced admissions. Health Aff. 2013;32(12):2149–56. https://doi.org/10.1377/hlthaff.2013.0662.

    Article  Google Scholar 

  21. Hostetler B, Leikin JB, Timmons JA, Hanashiro PK, Kissane K. Patterns of use of an emergency department-based observation unit. Am J Ther. 2002;9(6):499–502. https://doi.org/10.1097/00045391-200211000-00007.

    Article  PubMed  Google Scholar 

  22. Ross MA, Compton S, Richardson D, Jones R, Nittis T, Wilson A. The use and effectiveness of an emergency department observation unit for elderly patients. Ann Emerg Med. 2003;41(5):668–77. https://doi.org/10.1067/mem.2003.153.

    Article  PubMed  Google Scholar 

  23. Ross MA, Hemphill RR, Abramson J, Schwab K, Clark C. The recidivism characteristics of an emergency department observation unit. Ann Emerg Med. 2009;56(1):34–41. https://doi.org/10.1016/j.annemergmed.2010.02.012.

    Article  Google Scholar 

  24. Wai S, Ma L, Kim E, Adekunle-Ojo A. The utility of the emergency department observation unit for children with abdominal pain. Pediatr Emerg Care. 2013;29(5):574–8. https://doi.org/10.1097/PEC.0b013e31828e572d.

    Article  PubMed  Google Scholar 

  25. Gaspoz J, Lee TH, Cook EF, Weisberg MC, Goldman L. Outcome of patients who were admitted to a new short-stay unit to “rule-out” myocardial infarction. Am J Cardiol. 1991;68(2):145–9. https://doi.org/10.1016/0002-9149(91)90734-3.

    Article  CAS  PubMed  Google Scholar 

  26. Goodacre S, Nicholl J, Dixon S, Cross E, Angelini K, Arnold J, et al. Randomised controlled trial and economic evaluation of a chest pain observation unit compared with routine care. BMJ. 2004;328(7434):254–7. https://doi.org/10.1136/bmj.37956.664236.EE.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Gruenberg CC, Breaud AH, Liu JH, Mitchell PM, Feldman JA, Nelson KP, et al. Are geriatric patients placed in an emergency department observation unit on a chest pain pathway more likely than non-geriatric patients to re-present to the hospital within 30 days? J Emerg Med. 2018;54(3):302–6. https://doi.org/10.1016/j.jemermed.2017.11.017.

    Article  PubMed  Google Scholar 

  28. Martsolf GR, Nuckols TK, Fingar KR, Barrett ML, Stocks C, Owens PL. Nonspecific chest pain and hospital revisits within 7 days of care: variation across emergency department, observation and inpatient visits. BMC Health Serv Res. 2020;20(1):1–516. https://doi.org/10.1186/s12913-020-05200-x.

    Article  Google Scholar 

  29. Terry N, Franks N, Moran T, Pitts S, Osborne A, Ross MA. The changing role of chest pain in the emergency department observation unit. Crit Pathw Cardiol. 2021;20(3):119–125. https://doi.org/10.1097/HPC.0000000000000253.

  30. Schultz H, Qvist N, Mogensen CB, Pedersen BD. Discharge from an emergency department observation unit and a surgical assessment unit: experiences of patients with acute abdominal pain. J Clin Nurs. 2014;23(19–20):2779–89. https://doi.org/10.1111/jocn.12527.

    Article  PubMed  Google Scholar 

  31. Southerland LT, Simerlink SR, Vargas AJ, Krebs M, Nagaraj L, Miller KN, et al. Beyond observation: protocols and capabilities of an emergency department observation unit. Am J Emerg Med. 2019;37(10):1864–70. https://doi.org/10.1016/j.ajem.2018.12.049.

    Article  PubMed  Google Scholar 

  32. Brownlee S, Colucci J, Walsh T. What ‘Health Care Costs’ Really Means. In: Health. The Atlantic. 2012. https://www.theatlantic.com/health/archive/2012/12/what-health-care-costs-really-means/266522/.

  33. Papanicolas I, Woskie LR, Jha AK. Health care spending in the United States and other high-income countries. JAMA. 2018;319(10):1024–39. https://doi.org/10.1001/jama.2018.1150.

    Article  PubMed  Google Scholar 

  34. Shrank WH, Rogstad TL, Parekh N. Waste in the US health care system: estimated costs and potential for savings. JAMA. 2019;322(15):1501–9. https://doi.org/10.1001/jama.2019.13978.

    Article  PubMed  Google Scholar 

  35. Mitchell JB. Physician DRGs. N Engl J Med. 1985;313(11):670–5. https://doi.org/10.1056/NEJM198509123131106.

    Article  CAS  PubMed  Google Scholar 

  36. Baugh CW, Venkatesh AK, Bohan JS. Emergency department observation units: a clinical and financial benefit for hospitals. Health Care Manage Rev. 2011;36(1):28–37. https://doi.org/10.1097/HMR.0b013e3181f3c035.

    Article  PubMed  Google Scholar 

  37. Hockenberry JM, Mutter R, Barrett M, Parlato J, Ross MA. Factors associated with prolonged observation services stays and the impact of long stays on patient cost. Health Serv Res. 2014;49(3):893–909. https://doi.org/10.1111/1475-6773.12143.

    Article  PubMed  Google Scholar 

  38. Alese OB, Zhang C, Zakka KM, Kim S, Wu C, Shaib W, et al. A cost analysis of managing cancer-related pain among hospitalized US cancer patients. J Clin Oncol. 2020;38(15):7079. https://doi.org/10.1200/JCO.2020.38.15_suppl.7079.

    Article  Google Scholar 

  39. Baugh CW, Venkatesh AK, Hilton JA, Samuel PA, Schuur JD, Stephen Bohan J. Making greater use of dedicated hospital observation units for many short-stay patients could save $3.1 billion a year. Health Aff. 2012;31(10):2314–2323. https://doi.org/10.1377/hlthaff.2011.0926.

  40. Goodacre S, Morris F, Arnold J, Angelini K. Is a chest pain observation unit likely to be cost saving in a British hospital? Emerg Med J. 2001;18(1):11–4. https://doi.org/10.1136/emj.18.1.11.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. Numico G, Cristofano A, Mozzicafreddo A, Cursio OE, Franco P, Courthod G, et al. Hospital admission of cancer patients: avoidable practice or necessary care? PLoS One. 2015;10(3):e0120827. https://doi.org/10.1371/journal.pone.0120827.

  42. Caterino JM, Adler D, Durham DD, Yeung SJ, Hudson MF, Bastani A, et al. Analysis of diagnoses, symptoms, medications, and admissions among patients with cancer presenting to emergency departments. JAMA Netw Open. 2019;2(3):e190979. https://doi.org/10.1001/jamanetworkopen.2019.0979.

  43. •• Chaftari P, Lipe DN, Wattana MK, Qdaisat A, Krishnamani PP, Thomas J, et al. Outcomes of patients placed in an emergency department observation unit of a comprehensive cancer center. JCO Oncol Pract. 2021. https://doi.org/10.1200/OP.21.00478. (This 2021 study is the most recent study to demonstrate the capabilities of an EDOU in the care of patients with cancer.)

  44. Lipitz-Snyderman A, Klotz A, Atoria CL, Martin S, Groeger J. Impact of observation status on hospital use for patients with cancer. J Oncol Pract. 2015;11(2):73–77. https://doi.org/10.1200/JOP.2014.001248.

  45. Guinan JL, McGuckin M, Nowell PC. Management of health-care–associated infections in the oncology patient. Oncology (Huntington, N Y ). 2003;17(3):415–6.

    Google Scholar 

  46. Caterino JM, Adler D, Durham DD, Yeung SJ, Hudson MF, Bastani A, et al. Analysis of diagnoses, symptoms, medications, and admissions among patients with cancer presenting to emergency departments. JAMA Netw Open. 2019;2(3):e190979. https://doi.org/10.1001/jamanetworkopen.2019.0979.

  47. Gallaway MS, Idaikkadar N, Tai E, Momin B, Rohan EA, Rownsend J, et al. Emergency department visits among people with cancer: frequency, symptoms, and characteristics. J Am Coll Emerg Physicians Open. 2021;2(3):n/a. https://doi.org/10.1002/emp2.12438.

  48. Rivera DR, Gallicchio L, Brown J, Liu B, Kyriacou DN, Shelburne N. Trends in adult cancer–related emergency department utilization: an analysis of data from the nationwide emergency department sample. JAMA Oncol. 2017;3(10):e172450. https://doi.org/10.1001/jamaoncol.2017.2450.

  49. Hsu J, Donnelly JP, Moore JX, Meneses K, Williams G, Wang HE. National characteristics of emergency department visits by patients with cancer in the United States. Am J Emerg Med. 2018;36(11):2038–43. https://doi.org/10.1016/j.ajem.2018.03.025.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Hall WH, Ramachandran R, Narayan S, Jani AB, Vijayakumar S. An electronic application for rapidly calculating Charlson comorbidity score. BMC Cancer. 2004;4(1):94. https://doi.org/10.1186/1471-2407-4-94.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Lipitz-Snyderman A, Klotz A, Gennarelli RL, Groeger J. A population-based assessment of emergency department observation status for older adults with cancer. J Natl Compr Canc Netw. 2017;15(10):1234–1239. https://doi.org/10.6004/jnccn.2017.0160.

Download references

Acknowledgements

The authors thank Sarah Bronson, ELS, from the Research Medical Library at The University of Texas MD Anderson Cancer Center for editing this manuscript.

Author information

Authors and Affiliations

  1. Department of Emergency Medicine, Baylor College of Medicine, Houston, TX, USA

    Pavitra P. Krishnamani

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

    Marcelo Sandoval, Patrick Chaftari, Demis N. Lipe, Aiham Qdaisat, Ahmed Elsayem & Monica K. Wattana

Authors
  1. Pavitra P. Krishnamani
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marcelo Sandoval
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Patrick Chaftari
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Demis N. Lipe
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Aiham Qdaisat
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ahmed Elsayem
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Monica K. Wattana
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Pavitra P. Krishnamani.

Ethics declarations

Conflict of Interest

The authors declare no competing interests.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical collection on Palliative Medicine

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Krishnamani, P.P., Sandoval, M., Chaftari, P. et al. The Value Proposition of Observation Medicine in Managing Acute Oncologic Pain. Curr Oncol Rep 24, 595–602 (2022). https://doi.org/10.1007/s11912-022-01245-9

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11912-022-01245-9

Keywords

Search

Navigation