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Mortality in Emergency Surgical Oncology

  • Healthcare Policy and Outcomes
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Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Purpose

Cancer patients can experience problems related to their disease or treatment. This study evaluated reasons for presentation at the emergency room (ER) and outcome of surgical oncology patients.

Methods

A retrospective chart review for all surgical oncology patients who presented at the ER of the UMCG for surgical consultation between October 1, 2012, and March 31, 2013.

Results

A total of 200 cancer patients visited the ER for surgical consultation: 53.5 % with complications of (previous) cancer treatment, 25.5 % with symptoms caused by malignant disease, and 21.0 % with symptoms not related to cancer or cancer treatment. The 30-day mortality rate for patients with progressive disease was 25.5 %, and overall mortality rate was 62.8 %. The most frequent reason for ER presentation was intestinal obstruction (26.5 %), of which 41.5 % was malignant. Most cancer patients (59.5 %) did not undergo surgery during follow-up. The 30-day mortality for these patients was 14.3 % and overall mortality was 37.8 %. Most patients who died within the first 30 days after ER presentation had not undergone any surgery after presentation (89.5 %).

Conclusions

There is great variation in mortality rates for cancer patients presenting at the ER for surgical consultation. The mortality in this study was greatest for patients with progressive disease (30-day mortality 25.5 % and overall mortality 62.8 %), and the majority of patients who died within 30 days (89.5 %) had not undergone surgery after ER presentation. Surgery should only be performed in the acute setting when essential and when the expected outcome is favorable for the patient.

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References

  1. Barnett A, Cedar A, Siddiqui F, et al. Colorectal cancer emergencies. J Gastrointest Cancer. 2013;44(2):132–42.

    Article  PubMed  Google Scholar 

  2. Cervantes A, Chirivella I. Oncological emergencies. Ann Oncol. 2004;15 (Suppl. 4):iv299–iv306.

    Google Scholar 

  3. Katabathina VS, Restrepo CS, Betancourt Cuellar SL, et al. Imaging of oncologic emergencies: what every radiologist should know. Radiographics. 2013;33(6):1533–53.

    Article  PubMed  Google Scholar 

  4. Higdon ML, Higdon JA. Treatment of oncologic emergencies. Am Fam Physician. 2006;74(11):1873–80.

    PubMed  Google Scholar 

  5. Swenson KK, Rose MA, Ritz L, et al. Recognition and evaluation of oncology-related symptoms in the emergency department. Ann Emerg Med. 1995;26(1):12–7.

    Article  CAS  PubMed  Google Scholar 

  6. Hargarten SW, Richards MJ, Anderson AJ. Cancer presentation in the emergency department: a failure of primary care. Am J Emerg Med. 1992;10(4):290–3.

    Article  CAS  PubMed  Google Scholar 

  7. Mayer DK, Travers D, Wyss A, et al. Why do patients with cancer visit emergency departments? Results of a 2008 population study in North Carolina. J Clin Oncol. 2011;29(19):2683–8.

    Article  PubMed Central  PubMed  Google Scholar 

  8. Vandyk AD, Harrison MB, Macartney G, et al. Emergency department visits for symptoms experienced by oncology patients: a systematic review. Support Care Cancer. 2012;20(8):1589–99.

    Article  PubMed  Google Scholar 

  9. Hohenberger P, Buchheidt D. Surgical interventions in patients with hematologic malignancies. Crit Rev Oncol Hematol. 2005;55(2):83–91.

    Article  PubMed  Google Scholar 

  10. Geraci JM, Tsang W, Valdres RV, Escalante CP. Progressive disease in patients with cancer presenting to an emergency room with acute symptoms predicts short-term mortality. Support Care Cancer. 2006;14(10):1038–45.

    Article  PubMed  Google Scholar 

  11. Barbera L, Taylor C, Dudgeon D. Why do patients with cancer visit the emergency department near the end of life? CMAJ. 2010;182(6):563–8.

    Article  PubMed Central  PubMed  Google Scholar 

  12. Porta M, Fernandez E, Belloc J, et al. Emergency admission for cancer: a matter of survival? Br J Cancer. 1998;77(3):477–84.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  13. Tsang C, Bottle A, Majeed A, Aylin P. Cancer diagnosed by emergency admission in England: an observational study using the general practice research database. BMC Health Serv Res. 2013;13:308.

    Article  PubMed Central  PubMed  Google Scholar 

  14. McArdle CS, Hole DJ. Emergency presentation of colorectal cancer is associated with poor 5-year survival. Br J Surg. 2004;91(5):605–9.

    Article  CAS  PubMed  Google Scholar 

  15. Cuffy M, Abir F, Audisio RA, Longo WE. Colorectal cancer presenting as surgical emergencies. Surg Oncol. 2004;13(2–3):149–57.

    Article  PubMed  Google Scholar 

  16. Rutkowski P, Ruka W. Emergency surgery in the era of molecular treatment of solid tumours. Lancet Oncol. 2009;10(2):157–63.

    Article  PubMed  Google Scholar 

  17. Kasakura Y, Ajani JA, Mochizuki F, et al. Outcomes after emergency surgery for gastric perforation or severe bleeding in patients with gastric cancer. J Surg Oncol. 2002;80(4):181–5.

    Article  PubMed  Google Scholar 

  18. Bosscher MR, van Leeuwen BL, Hoekstra HJ. Surgical emergencies in oncology. Cancer Treat Rev. 2014;40(8):1028–36.

    Article  CAS  PubMed  Google Scholar 

  19. Chiarugi M, Galatioto C, Panicucci S, et al. Oncologic colon cancer resection in emergency: are we doing enough? Surg Oncol. 2007;16 (Suppl 1):S73–S7.

    Article  PubMed  Google Scholar 

  20. Greenberg CC, Lipsitz SR, Neville B, et al. Receipt of appropriate surgical care for Medicare beneficiaries with cancer. Arch Surg. 2011;146(10):1128–34.

    Article  PubMed Central  PubMed  Google Scholar 

  21. McCurdy MT, Shanholtz CB. Oncologic emergencies. Crit Care Med. 2012;40(7):2212–22.

    Article  PubMed  Google Scholar 

  22. Sussman JJ. Surgical emergencies in the cancer patient. In: Norton JA, ed. Surgery; Basic science and clinical evidence. New York: Springer, 2007; pp 2117–122.

    Google Scholar 

  23. Prost ALDJ, Douard R, Malamut G, et al. Small bowel obstruction in patients with a prior history of cancer: predictive findings of malignant origins. World J Surg. 2014; 38(2):363–9.

    Article  Google Scholar 

  24. Kogut MJ, Bastawrous S, Padia S, Bhargava P. Hepatobiliary oncologic emergencies: imaging appearances and therapeutic options. Curr Probl Diagn Radiol. 2013;42(3):113–26.

    Article  PubMed  Google Scholar 

  25. Thomas CR, Jr., Wood LV, Douglas JG, et al. Common emergencies in cancer medicine: infectious and treatment-related syndromes, Part I. J Natl Med Assoc. 1994;86(10):765–74.

    Google Scholar 

  26. Turnbull AD, Guerra J, Starnes HF. Results of surgery for obstructing carcinomatosis of gastrointestinal, pancreatic, or biliary origin. J Clin Oncol. 1989;7(3):381–6.

    CAS  PubMed  Google Scholar 

  27. Stellato TA, Shenk RR. Gastrointestinal emergencies in the oncology patient. Semin Oncol. 1989;16(6):521–31.

    CAS  PubMed  Google Scholar 

  28. Ketcham AS, Hoye RC, Pilch YH, Morton DL. Delayed intestinal obstruction following treatment for cancer. Cancer. 1970;25(2):406–10.

    Article  CAS  PubMed  Google Scholar 

  29. Sagar J. Colorectal stents for the management of malignant colonic obstructions. Cochrane Database Syst Rev. 2011;11:CD007378.

  30. Harrison ME, Anderson MA, Appalaneni V, et al. The role of endoscopy in the management of patients with known and suspected colonic obstruction and pseudo-obstruction. Gastrointest Endosc. 2010;71(4):669–79.

    Article  PubMed  Google Scholar 

  31. Kolomainen DF, Daponte A, Barton DP, et al. Outcomes of surgical management of bowel obstruction in relapsed epithelial ovarian cancer (EOC). Gynecol Oncol. 2012;125(1):31–6.

    Article  CAS  PubMed  Google Scholar 

  32. Miller G, Boman J, Shrier I, Gordon PH. Small-bowel obstruction secondary to malignant disease: an 11-year audit. Can J Surg. 2000;43(5):353–8.

    PubMed Central  CAS  PubMed  Google Scholar 

  33. Abbas SM, Merrie AE. Resection of peritoneal metastases causing malignant small bowel obstruction. World J Surg Oncol. 2007;5:122.

    Article  PubMed Central  PubMed  Google Scholar 

  34. Mangili G, Scambia G, Ottolina J, et al. Comparison of optimal cytoreduction rates in emergency versus non-emergency admissions for advanced ovarian cancer: a multi-institutional study. Eur J Surg Oncol. 2013;39(8):906–11.

    Article  CAS  PubMed  Google Scholar 

  35. Kwok AC, Semel ME, Lipsitz SR, et al. The intensity and variation of surgical care at the end of life: a retrospective cohort study. Lancet. 2011;378(9800):1408–13.

    Article  PubMed  Google Scholar 

  36. Weiser TG, Semel ME, Simon AE, et al. In-hospital death following inpatient surgical procedures in the United States, 1996–2006. World J Surg. 2011;35(9):1950–6.

    Article  PubMed  Google Scholar 

  37. Semel ME, Lipsitz SR, Funk LM, et al. Rates and patterns of death after surgery in the United States, 1996 and 2006. Surgery. 2012;151(2):171–82.

    Article  PubMed  Google Scholar 

  38. Kim SP, Feinglass J, Bennett CL, et al. Merging claims databases with a tumor registry to evaluate variations in cancer mortality: results from a pilot study of 698 colorectal cancer patients treated at one hospital in the 1990s. Cancer Invest. 2004;22(2):225–33.

    Article  PubMed  Google Scholar 

  39. Barnet CS, Arriaga AF, Hepner DL, et al. Surgery at the end of life: a pilot study comparing decedents and survivors at a tertiary care center. Anesthesiology. 2013;119(4):796–801.

  40. Kwok AC, Lipsitz SR, Bader AM, Gawande AA. Are targeted preoperative risk prediction tools more powerful? A test of models for emergency colon surgery in the very elderly. J Am Coll Surg. 2011;213(2):220–5.

    Article  PubMed  Google Scholar 

  41. Ibrahim T, Mercatali L, Amadori D. A new emergency in oncology: bone metastases in breast cancer patients (Review). Oncol Lett. 2013;6(2):306–10.

    PubMed Central  PubMed  Google Scholar 

  42. Wright AA, Mack JW, Kritek PA, et al. Influence of patients’ preferences and treatment site on cancer patients’ end-of-life care. Cancer. 2010;116(19):4656–63.

    Article  PubMed Central  PubMed  Google Scholar 

  43. Rocque GB, Barnett AE, Illig LC, et al. Inpatient hospitalization of oncology patients: are we missing an opportunity for end-of-life care? J Oncol Pract. 2013;9(1):51–4.

    Article  PubMed Central  PubMed  Google Scholar 

  44. Yates M, Barrett A. Oncological emergency admissions to the Norfolk and Norwich University Hospital: an audit of current arrangements and patient satisfaction. Clin Oncol (R Coll Radiol). 2009;21(3):226–33.

    Article  CAS  PubMed  Google Scholar 

  45. Seow H, Barbera L, Howell D, Dy SM. Using more end-of-life homecare services is associated with using fewer acute care services: a population-based cohort study. Med Care. 2010;48(2):118–24.

    Article  PubMed  Google Scholar 

  46. Burge F, Lawson B, Johnston G. Family physician continuity of care and emergency department use in end-of-life cancer care. Med Care. 2003;41(8):992–1001.

    Article  PubMed  Google Scholar 

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Acknowledgment

M.R.F. Bosscher, MD, received a Research Grant from the Groningen Melanoma and Sarcoma Foundation.

Disclosure

Nothing to disclose.

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Authors and Affiliations

  1. Department of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands

    M. R. F. Bosscher MD, B. L. van Leeuwen MD, PhD & H. J. Hoekstra MD, PhD

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  1. M. R. F. Bosscher MD
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  2. B. L. van Leeuwen MD, PhD
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  3. H. J. Hoekstra MD, PhD
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Corresponding author

Correspondence to M. R. F. Bosscher MD.

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Bosscher, M.R.F., van Leeuwen, B.L. & Hoekstra, H.J. Mortality in Emergency Surgical Oncology. Ann Surg Oncol 22, 1577–1584 (2015). https://doi.org/10.1245/s10434-014-4180-x

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  • DOI: https://doi.org/10.1245/s10434-014-4180-x

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