Integrating palliative care in oncologic emergency departments: Challenges and opportunities

Table 1 Symptoms of cancer patients visiting emergency departments

Ref.	Country	Sample size	Study design	Most common symptoms (n)	Most common cancers
Mayer et al[4]	United States	27644	Retrospective	Pain (9000)	Lung
				Respiratory (5856)	Breast
				Gastrointestinal (3280)	Colon
					Prostate
Barbera et al[20]	Canada	76759	Retrospective	Abdominal pain (9224)	Lung
				Dyspnea (6171)	Pancreatic
				Malaise (4972)	Breast
				Chest pain (4463)
Yildirim et al[22]	Turkey	107	Retrospective	Dyspnea	Lung
				Pain
Vandyk et al[23]	Canada	18 studies with a median sample size of 143	Meta-analysis	Febrile neutropenia Infection Pain Fever Dyspnea	Multiple

Table 2 Hospital admissions and outcomes for cancer patients visiting emergency departments

Ref.	Country	Sample size	Hospital admission rate	Deaths
Vandyk et al[23]	Canada	16 studies	58%	13% (hospital)
Mayer et al[4]	United States	37760	63%	283 (ED)
Yildirim et al[22]	Turkey	107	60%	9% (ED)

ED: Emergency department.

Table 3 Benefits and challenges associated with integration of palliative care into emergency medicine

Benefits	Challenges
Control pain and other symptoms early	ED culture of fast pace, timely intervention, and save life
Address emotional distress in patients and families early	Time constraints
Address goals of care and resuscitation preferences	Overcrowding
Prevent unnecessary hospitalization	Limited resources
Reduce admissions to ICUs	Delays in palliative care consultations
Reduce length of hospital stay	Patient’s and family’s expectations
Reduce costs

ICUs: Intensive care units; ED: Emergency department.

Table 4 Programs to reduce Emergency visits and hospitalization for patients receiving palliative care

Ref./country	Study	Objective	Intervention/observation	Outcome
Prudy et al[36] United Kingdom	Marie curie cancer care DCP	Help PC patients die at home and avoid emergency department visits	(1) Expedited hospital discharges for terminal patients; (2) After hour specialist PC nurses to respond to patients, families, and clinicians	Patients who used DCP are 30% less likely to die in hospital
Wiese et al[40] Germany	Quality of out-of-hospital emergency medical team. Prospective Multicenter Analysis	To evaluate the impact of physician’s expertise in PC and emergency care on the outcome of emergency call for PC patients in the community	Number of ICU admissions, PC unit admission, general ward admission, and discharge after ambulatory care	Physicians with expertise in PC provided a better quality end of life care with less ICU admissions and more PC unit admission
Mercadante et al[39] Italy	Emergencies in patients with advanced cancer followed at home	Assess the frequency and reasons of emergency calls by patients receiving palliative care at home	Characteristic and outcome of consecutive emergency calls	Of 689 patients; 17% made emergency calls. Main reasons were dyspnea, pain, and delirium. Family initiated most calls
Porzio et al[37] Italy	Integrating oncology and palliative home care in Italy	Evaluate efficacy of home care program integrated with a medical oncology unit	Compare outcome of patients from the integrated oncology program to other patients coming from other hospitals	Patients in the integrated program had longer length of stay at home, less emergency calls, less hospitalization, and more death at home
Alonso-Babarro et al[38] Spain	Association between inpatient death, utilization of hospital resources and availability of PC	Evaluate the impact of community PC service on use of hospital resources in 2 areas with and without PC	(1) Use of emergency calls; (2) Hospital death; (3) Emergency visit and hospitalization	Community with PC service had less emergency calls, less hospitalization and inpatient death

ICU: Intensive care unit; PC: Palliative care; DCP: Delivering choice program.