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Increased Emergency Department Utilization and Costs for Medicare Cancer Patients with Malnutrition Diagnoses



Malnutrition or its risk affects up to 70% of cancer patients. Compared to adequately nourished oncology patients, those with malnutrition experience more complications and have poorer prognoses, thus higher needs for healthcare. We compared utilization of emergency department (ED) services and costs for Medicare-covered cancer patients with or without a malnutrition diagnosis.


We used the Centers for Medicare & Medicaid Services (CMS) Standard Analytic File to identify fee-for-service beneficiaries who had a cancer diagnosis, and had one or more outpatient claims in 2018. We totaled individual claims and costs for ED visits per beneficiary, then calculated mean per-person claims and costs for malnourished vs non-malnourished patients.


Using data from over 2.8 million claims of patients with cancer diagnoses, the prevalence of diagnosed malnutrition was 2.5%. The most common cancer types were genitourinary, hematologic/blood, and breast. Cancer patients with a malnutrition diagnosis, compared to those without, had a significantly higher annual total number of outpatient claims (21.4 vs. 11.5, P<.0001), including a 2.5-fold higher rate of ED visits (1.43 vs. 0.56, p<.0001). As result, such patients incurred more than 2-fold higher mean ED claim costs than did their adequately nourished counterparts ($10,724 vs. $4,935, P<.0001).


Our results suggest that malnutrition in cancer patients imposes a high outpatient burden on resource utilization and costs of care in terms of ED use. We propose that nutritional interventions can be used to improve health outcomes for people with cancer and to improve economic outcomes for patients and providers.

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Availability of data and material: Data were obtained from the public CMS Standard Analytic Files (SAF) using information for the Calendar Year 2018


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We thank Cecilia Hofmann, PhD (C. Hofmann & Associates, Western Springs, IL) for her critical review and editing of the manuscript and with bibliography management.


Funding: Analysis for this study were financially supported by Abbott, USA.

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Authors and Affiliations



Authors’ contributions: SS, CB, SD, GW, participated in design of the analysis, and GW performed data analysis. As well, RH, MB and other authors contributed to writing, editing, and reviewing the manuscript content.

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Correspondence to Suela Sulo.

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Conflicts of interest: SS, CB, SD, and RH are employees and stockholders of Abbott. GW received funding for conducting this CMS data analysis. MB is a member of the Speakers’ Bureau for Abbott.

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Code availability: SAS 9.4 software.

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Sulo, S., Brunton, C., Drawert, S. et al. Increased Emergency Department Utilization and Costs for Medicare Cancer Patients with Malnutrition Diagnoses. J Nutr Health Aging 26, 786–791 (2022).

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Key words

  • Cancer
  • malnutrition
  • emergency department
  • Medicare
  • healthcare costs