Skip to main content
SpringerLink
Log in

Krebspatienten in der Notaufnahme

Cancer patients in the emergency department

  • Übersichten
  • Published:
Medizinische Klinik - Intensivmedizin und Notfallmedizin Aims and scope Submit manuscript

Zusammenfassung

Die Anzahl der mit einer malignen Grunderkrankung lebenden Patienten steigt stetig an. Damit verbundene krankheits- oder therapieassoziierte Komplikationen sowie die aufgrund des zunehmenden Lebensalters manifesten Komorbiditäten führen zu einer erheblichen und steigenden Inanspruchnahme akut- und notfallmedizinischer Ressourcen. Krebspatienten konsultieren Notaufnahmen zumeist mit Abgeschlagenheit, Dyspnoe, Fieber, Schmerzen, gastrointestinalen oder neurologischen Symptomen. Die Hospitalisierungs- und Intensivstationsaufnahmeraten sind hoch. Die respiratorische Insuffizienz bedarf umgehender Diagnostik. Hier zeigt sich eine Überlegenheit der Computertomographie gegenüber der konventionellen Röntgenaufnahme des Thorax. Die Vermeidung einer notwendigen Intubation oder Verzögerung intensivmedizinischer Maßnahmen ist mit hoher Mortalität assoziiert. Fieber ist ein Notfall mit sofortiger Notwendigkeit einer antiinfektiven Therapie. Die Therapie der Sepsis differiert nicht bei neutropenen und nichtneutropenen Patienten. Kardiovaskuläre Erkrankungen sind, teils therapieassoziiert, einer der häufigsten Gründe für Langzeitmorbidität und -mortalität bei Krebspatienten. Immunvermittelte Komplikationen treten zunehmend und teils vital bedrohlich auf, können aber leicht verkannt werden. Spezifische Notfälle, wie Leukostase, Tumorlyse oder Hyperkalzämie, sind eher selten in der Notaufnahme und bedürfen einer interdisziplinären Behandlung. Aufgrund steigender Patientenzahlen ist von einer Zunahme der notfallmedizinischen Behandlungen auszugehen. Die Kenntnis therapieassoziierter Komplikationen ist für Notfallmediziner von zunehmender Bedeutung. Die Vermeidung aggressiver Behandlungsmaßnahmen am Lebensende sollte angestrebt werden.

Abstract

A growing number of patients are living with cancer or have a history of cancer leading to increasing adverse effects of treatment or disease necessitating emergency department (ED) consultation. Long-term cancer survivors are at higher risk of comorbidities causing a substantial increase in health care resource utilization. The most frequent reasons for cancer-related ED visits are dyspnea, fever, pain, gastrointestinal or neurological symptoms leading to high hospital and intensive care unit admission rates. Acute respiratory failure in cancer patients necessitates timely diagnostic testing, whereby computed tomography is superior to chest X‑ray. Delay in intensive care unit (ICU) admission or mechanical ventilation increases mortality. Febrile neutropenia is an emergency with urgent need for antibiotic treatment. Treatment of neutropenic and nonneutropenic patients with sepsis does not differ. Cardiovascular disease is now the second leading cause of long-term morbidity and mortality among cancer survivors. Immunotherapy can lead to substantial and in some patients life-threatening complications that may not easily be recognized in the ED. Cancer-specific emergencies such as leukostasis, tumorlysis or hypercalcemia rarely present to ED and require interdisciplinary care. The constantly growing cancer population is likely to increase ED utilization. Knowledge about cancer treatment and disease-associated complications is crucial for emergency physicians. Palliative care education should secure appropriate end-of-life care avoiding futile interventions.

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

Abb. 1
Abb. 2

Literatur

  1. André S, Taboulet P, Elie C et al (2010) Febrile neutropenia in French emergency departments: results of a prospective multicentre survey. Crit Care 14(2):R68. https://doi.org/10.1186/cc8972

    Article  PubMed  PubMed Central  Google Scholar 

  2. Azoulay E, Canet E, Raffoux E et al (2012) Dexamethasone in patients with acute lung injury from acute monocytic leukaemia. Eur Respir J 39(3):648–653. https://doi.org/10.1183/09031936.00057711

    Article  CAS  PubMed  Google Scholar 

  3. Azoulay E, Pickkers P, Soares M et al (2017) Acute hypoxemic respiratroy failure in immuncompromised patients: the Efraim multinational prospective cohort study. Intensive Care Med 43(12):1808–1819. https://doi.org/10.1007/s00134-017-4947-1

    Article  PubMed  Google Scholar 

  4. Borrega GJ, Heindel K, Kochanek M et al (2021) The critically ill CAR T‑cell patient: relevant toxicities, their management and challenges in critical care. Med Klin Intensivmed Notfmed 116(2):121–128. https://doi.org/10.1007/s00063-021-00780-w

    Article  CAS  Google Scholar 

  5. Cairo MS, Coiffier B, Reiter A et al (2010) Recommendations for the evaluation of risk and prophylaxis of tumour lysis syndrome (TLS) in adults and children with malignant diseases: an expert TLS panel consensus. Br J Haematol 149(4):578–586. https://doi.org/10.1111/j.1365-2141.2010.08143.x

    Article  CAS  PubMed  Google Scholar 

  6. Courtney DM, Aldeen AZ, Gorman SM et al (2007) Cancer-associated neutropenic fever: clinical outcome and economic costs of emergency department care. Oncologist 12(8):1019–1026. https://doi.org/10.1634/theoncologist.12-8-1019

    Article  PubMed  Google Scholar 

  7. Cserna J, Baumann CK, Lobmeyr E et al (2023) Emergency department utilization following allogeneic hematopoietic stem cell transplantation: a single-center retrospective longitudinal analysis of 557 patients. Transplant Cell Ther 29(5):321.e1–321.e9. https://doi.org/10.1016/j.jtct.2023.02.018

    Article  PubMed  Google Scholar 

  8. Curigliano G, Cardinale D, Dent S et al (2016) Cardiotoxicity of anticancer treatments: epidemiology, detection and management. CA Cancer J Clin 66(4):309–325. https://doi.org/10.3322/caac.21341

    Article  PubMed  Google Scholar 

  9. Drumheller BC, Agarwal A, Mikkelsen M et al (2016) Risk factors for mortality despite early protocolized resuscitation for severe sepsis and septic shock in the emergency department. J Crit Care 31(1):13–20. https://doi.org/10.1016/j.jcrc.2015.10.015

    Article  PubMed  Google Scholar 

  10. Gerritsen MG, Willemink MJ, Pompe E et al (2017) Improving early diagnosis of pulmonary infections in patients with febrile neutropenia using low-dose chest computed tomography. Plos One 12(2):e172256. https://doi.org/10.1371/journal.pone.0172256

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Haas NL, Nafday A, Cranford JA, Yentz SE, Bixby DL, Bassin BS (2020) Implementation of a multidisciplinary care pathway via an emergency department-ICU to improve care of emergency department patients presenting with Leukostasis. Crit Care Explor 2(2):e84. https://doi.org/10.1097/CCE.0000000000000084

    Article  PubMed  PubMed Central  Google Scholar 

  12. Herbert A, Abel GA, Winters S, McPhail S, Elliss-Brookes L, Lyratzopoulos G (2019) Cancer diagnoses after emergency GP referral or A&E attendance in England: determinants and time trends in Routes to Diagnosis data, 2006–2015. Br J Gen Pract 69:e724–e730. https://doi.org/10.3399/bjgp19X705473

    Article  PubMed  PubMed Central  Google Scholar 

  13. Jones GL, Will A, Jackson GH et al (2015) Guidelines for the management of tumour Lysis syndrome in adults and children with haematological malignancies on behalf of the British committee for standards in Haematology. Br J Haematol 169:661–671. https://doi.org/10.1111/bjh.13403

    Article  PubMed  Google Scholar 

  14. Keng MK, Thallner EA, Elson P et al (2015) Reducing time to antibiotic administration for febrile neutropenia in the emergency department. J Oncol Pract 11(6):450–455. https://doi.org/10.1200/JOP.2014.002733

    Article  PubMed  Google Scholar 

  15. Kenzik KM, Johnson PC, Bhatia R et al (2022) Assessment of hospitalizations and emergency department visits after chimeric antigen receptor T‑Cell therapy among commercially insured patients. JAMA Oncol 8(7):1068–1070. https://doi.org/10.1001/jamaoncol.2022.1044

    Article  PubMed  PubMed Central  Google Scholar 

  16. Kenigsberg B, Wellstein A, Barac A (2018) Left ventricular dysfunction in cancer treatment. JACC Heart Fail 6(2):87–95. https://doi.org/10.1016/j.jchf.2017.08.024

    Article  PubMed  Google Scholar 

  17. Kiehl M, Beutel G, Böll B et al (2018) Consensus statement for cancer patients requiring intensive care support. Ann Hematol 97(7):1271–1282. https://doi.org/10.1007/s00277-018-3312-y

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Kim K, Chakravarthy B, Anderson C et al (2017) To Intubate or not to Intubate: emergency medicine physicians’ perspective on intubating critically ill, terminal cancer patients. J Pain Symptom Manage 54(5):654–660.e1. https://doi.org/10.1016/j.jpainsymman.2017.07.038

    Article  PubMed  Google Scholar 

  19. Kochanek M, Kiehl M, Liebregts T (2019) Intensive care management of severe infections in cancer patients. Dtsch Med Wochenschr 144(19):1333–1341. https://doi.org/10.1055/a-0853-4739

    Article  PubMed  Google Scholar 

  20. Kochanek M, Schalk E, von Bergwelt-Baildon M et al (2019) Management of sepsis in neutropenic cancer patients: 2018 guidelines from the infectious diseases working party (AGIHO) and intensive care working party (iCHOP) oft he German society of hematology and medical oncology (DGHO). Ann Hematol 98(5):1051–1069. https://doi.org/10.1007/s00277-019-03622-0

    Article  PubMed  PubMed Central  Google Scholar 

  21. Kochanek M, Shimabukuro-Vornhagen A, Rüß K et al (2020) Prevalence of cancer patients in german intensive care units. Med Klin Intensivmed Notfmed 115(4):312–319. https://doi.org/10.1007/s00063-019-0594-3

    Article  CAS  PubMed  Google Scholar 

  22. Kroschinsky F, Stölzel F, von Bonin S et al (2017) New drugs, new toxicities: severe side effects of modern targeted and immunotherapy of cancer and their management. Crit Care 21(1):89. https://doi.org/10.1186/s13054-017-1678-1

    Article  PubMed  PubMed Central  Google Scholar 

  23. Lemiale V, Resche-Rigon M, Mokart D et al (2017) High-flow nasal cannula oxygenation in Immunocompromised patients with acute hypoxemic respiratory failure: a groupe de recherche respiratoire en Réanimation Onco-Hématologique study. Crit Care Med 45(3):e274–e280. https://doi.org/10.1097/CCM.0000000000002085

    Article  PubMed  Google Scholar 

  24. Lindner G, Felber R, Schwarz C et al (2013) Hypercalcemia in the ED: prevalence, etiology, and outcome. Am J Emerg Med 31(4):657–660. https://doi.org/10.1016/j.ajem.2012.11.010

    Article  PubMed  Google Scholar 

  25. Livingston PM, Craike M, Slavin M (2012) Clinical and economic burden of emergency department presentations for neutropenia folloeing outpatient chemotherapy for cancer in Victoria, Australia. Oncologist 17(7):998–1004. https://doi.org/10.1634/theoncologist.2011-0456

    Article  PubMed  PubMed Central  Google Scholar 

  26. Mayer DK, Travers D, Wyss A et al (2011) Why do patients with cancer visit emergency departments? Results of a 2008 population study in North Carolina. J Clin Oncol 29(19):2683–2688. https://doi.org/10.1200/JCO.2010.34.2816

    Article  PubMed  PubMed Central  Google Scholar 

  27. Nauck F, Jaspers B (2021) Integration of palliative care into acute care medicine. Med Klin Intensivmed Notfmed 116(3):267–276. https://doi.org/10.1007/s00063-021-00792-6

    Article  PubMed  PubMed Central  Google Scholar 

  28. Perron T, Emara M, Ahmed S (2014) Time to antibiotics and outcomes in cancer patients with febrile neutropenia. BMC Health Serv Res 14:162. https://doi.org/10.1186/1472-6963-14-162

    Article  PubMed  PubMed Central  Google Scholar 

  29. Peyrony O, Tieghem Y, Franchitti J et al (2019) Immune checkpoint blockade toxicity among patients with cancer presenting tot he emergency department. Emerg Med J 36(5):306–309. https://doi.org/10.1126/sciadv.abg4081

    Article  CAS  PubMed  Google Scholar 

  30. Peyrony O, Fontaine JP, Beaune S et al (2020) EPICANCER—cancer patients presenting to the emergency departments in France. A prospective nationwide study. J Clin Med 9(5):1505. https://doi.org/10.3390/jcm9051505

    Article  PubMed  PubMed Central  Google Scholar 

  31. Probst L, Schalk E, Liebregts T et al (2019) Prognostic accuracy of SOFA, qSOFA and SIRS criteria in hematological cancer patients: a retrospective multicenter study. J Intensive Care 7:41. https://doi.org/10.1186/s40560-019-0396-y

    Article  PubMed  PubMed Central  Google Scholar 

  32. Pudil R, Mueller C, Celutkiene J et al (2020) Role of serum biomarkers in cancer patients receiving cardiotoxic cancer therapies: a position statement from the Cardio-Oncology Study Group of the Heart Failure Association and the Cardio-Oncology Council of the European Society of Cardiology. Eur J Heart Fail 22:1966–1983. https://doi.org/10.1002/ejhf.1957

    Article  CAS  PubMed  Google Scholar 

  33. Rivera DR, Gallicchio L, Brown J et al (2017) Trends in adult cancer-related emergency department utilization: an analysis of data from the nationwide emergency department sample. JAMA Oncol 3(10):e172450. https://doi.org/10.1001/jamaoncol.2017.2450

    Article  PubMed  PubMed Central  Google Scholar 

  34. Saillard C, Lambert J, Tramier M et al (2022) High-flow nasal cannula failure in critically ill cancer patients with acute respiratory failure: moving from avoiding intubation to avoiding delayed intubation. Plos One 17(6):e270138. https://doi.org/10.1371/journal.pone.0270138

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Schellongowski P, Staudinger T (2013) Leukostasis and tumor lysis: important complicatios of hyperleukocytosis. Internist 54(9):1051–1060. https://doi.org/10.1007/s00108-013-3260-5

    Article  CAS  PubMed  Google Scholar 

  36. Self WH, Courtney DM, McNaughton CD et al (2013) High discordance of chest x‑ray and computed tomography for detection of pulmonary opacities in ED patients: implications for diagnosing pneumonia. Am J Emerg Med 31(2):401–405. https://doi.org/10.1016/j.ajem.2012.08.041

    Article  PubMed  Google Scholar 

  37. Stahl M, Shallis RM, Wei W et al (2020) Management of hyperleukocytosis and impact of leukapheresis among patients with acute myeloid leukemia (AML) on short- and long-term clinical outcomes: a large, retrospective, multicenter, international study. Leukemia 34(12):3149–3160. https://doi.org/10.1038/s41375-020-0783-3

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Tsang C, Bottle A, Majeed A et al (2013) Cancer diagnosed by emergency admission in England: an observational study using the general practice research database. BMC Health Serv Res 13:308. https://doi.org/10.1186/1472-6963-13-308

    Article  PubMed  PubMed Central  Google Scholar 

  39. Van den Berk IAH, Lejeune EH, Kanglie MMNP et al (2023) The yield of Chest X‑ray or ultra-low-dose chest-CT in emergency department patients suspected of pulmonary infection without respiratory symptoms or signs. Eur Radiol. https://doi.org/10.1007/s00330-023-09664-3

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Klinik für Hämatologie und Stammzelltransplantation, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Deutschland

    Tobias Liebregts MBA, Catherina Lueck, Annemarie Mohring & Asterios Tzalavras

  2. Zentrum für Notfallmedizin, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Deutschland

    Joachim Riße

  3. Klinik für Hämatologie und Stammzelltransplantation, Universitätsklinikum Essen, Universität Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Deutschland

    Tobias Liebregts MBA

Authors
  1. Tobias Liebregts MBA
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Catherina Lueck
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Annemarie Mohring
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Joachim Riße
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Asterios Tzalavras
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tobias Liebregts MBA.

Ethics declarations

Interessenkonflikt

T. Liebregts, C. Lueck, A. Mohring, J. Riße und A. Tzalavras geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

Additional information

Redaktion

Michael Buerke, Siegen

figure qr

QR-Code scannen & Beitrag online lesen

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Liebregts, T., Lueck, C., Mohring, A. et al. Krebspatienten in der Notaufnahme. Med Klin Intensivmed Notfmed 119, 3–9 (2024). https://doi.org/10.1007/s00063-023-01055-2

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00063-023-01055-2

Schlüsselwörter

Keywords

Search

Navigation