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Unplanned emergency department visits and hospital admissions of older adults under treatment for cancer in the ambulatory/community setting

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Abstract

Purpose

This study aims to identify the incidence and risk/protective factors for (1) unplanned emergency department (ED) visits and hospital admissions (HA) and (2) nausea/vomiting/dehydration (NVD) at time of treatment in older adults under treatment for cancer.

Materials and methods

This is a exploratory retrospective cohort study of adults (60 and older) with cancer. Adults were included if they had a new cancer diagnosis and were being treated with chemotherapy. Study outcomes included the number of ED visits and HA (cycles 1–4) and NVD at the time of receiving chemotherapy (cycles 2–4). Repeated measures, Poisson regression was used to obtain risk ratios with 95% confidence intervals for independent predictors of outcomes.

Results

Of 402 study participants, 20% experienced an ED visit, and 18% experienced a HA. Common reasons for ED visits were pain (23.5%) and NVD (20.4%). Common reasons for HA were infection (34.4%) and NVD (22.2%). Multivariate analysis showed risk factors for ED visits included chemotherapy cycle 1, having esophageal cancer, being treated with ≥ 3 chemotherapy agents, and increasing levels of functional impairment. Risk factors for HA included chemotherapy cycle 1, increasing levels of functional impairment, intravenous fluids between treatment, and being prescribed antiemetics for home use. Predictors of NVD at time of chemotherapy treatment included Hispanic ethnicity, insurance status, cancer type, chemotherapy emetic potent, treatment frequency, intravenous fluids between cycles, and number of home antiemetics.

Conclusion

Unplanned ED visits and HA occur in older adults under treatment for cancer due to numerous treatment-related side effects. Helping older adults identify and manage side effects early may reduce the number of unplanned admissions.

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Authors and Affiliations

  1. College of Nursing, University of Central Florida, 12201 Research Parkway, Suite 300, Orlando, FL, 32816, USA

    Victoria Wochna Loerzel & Christine Wargo Deatrick

  2. College of Medicine, University of Central Florida, Orlando, FL, USA

    Robert B. Hines

  3. Orlando Health, Orlando, FL, USA

    Patricia I. Geddie

  4. School of Nursing and Health Studies, University of Miami, Miami, FL, USA

    John M. Clochesy

Authors
  1. Victoria Wochna Loerzel
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  2. Robert B. Hines
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  3. Christine Wargo Deatrick
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  4. Patricia I. Geddie
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  5. John M. Clochesy
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Contributions

All authors contributed to the conceptualization and design of this study. VWL, CWD, and PG extracted the data, RBH conducted the data analysis, and VWL drafted the manuscript; all authors reviewed, edited, and approved the final version and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Victoria Wochna Loerzel.

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This study was approved by the University of Central Florida IRB.

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Conflict of interest

J. Clochesy reports grants from the NIH during the conduct of this study.

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Loerzel, V.W., Hines, R.B., Deatrick, C.W. et al. Unplanned emergency department visits and hospital admissions of older adults under treatment for cancer in the ambulatory/community setting. Support Care Cancer 29, 7525–7533 (2021). https://doi.org/10.1007/s00520-021-06338-y

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  • DOI: https://doi.org/10.1007/s00520-021-06338-y

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