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Dufton PH, Gerdtz MF, Jarden R, Krishnasamy M. Factors that influence presentation to an emergency department during systemic anti-cancer therapy: An exploratory qualitative study. Eur J Oncol Nurs 2024; 70:102607. [PMID: 38795444 DOI: 10.1016/j.ejon.2024.102607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 04/20/2024] [Accepted: 05/07/2024] [Indexed: 05/28/2024]
Abstract
PURPOSE To explore factors that influence presentation to an emergency department during ambulatory systemic anti-cancer therapy. METHODS This study was an exploratory qualitative study using semi-structured interviews. A purposive sample of adult patients with any cancer who had commenced systemic anti-cancer therapy in the ambulatory setting up to six months prior participated in semi-structured interviews between November 2016-December 2017. Interviews were transcribed verbatim, and data analysed thematically using a template analysis approach. RESULTS Twenty patients and four caregivers took part. Five themes were generated from the interview data: 1) the unknown and unpredictable; 2) a change of lifestyle; 3) social determinants and access; 4) trust in care providers; and 5) the unavailability of care. CONCLUSION As the number of systemic anti-cancer agents and patients eligible for them continues to grow, identifying, implementing and evaluating initiatives to mitigate emergency department presentations present an important area for health services research. Addressing timely access to trusted care and enhancing patient capacity for self-management present important areas for nurse-led system innovation. Findings from this study offer important insights into where and how nurses can mitigate emergency department presentations for individuals receiving systemic anti-cancer therapy by enabling accessible, coordinated and person-centred cancer care.
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Affiliation(s)
- Polly H Dufton
- Department of Nursing, Dentistry and Health Sciences, University of Melbourne, Victoria, Australia; Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, Victoria, Australia.
| | - Marie F Gerdtz
- Department of Nursing, Dentistry and Health Sciences, University of Melbourne, Victoria, Australia
| | - Rebecca Jarden
- Department of Nursing, Dentistry and Health Sciences, University of Melbourne, Victoria, Australia; Austin Health, Victoria, Australia
| | - Meinir Krishnasamy
- Department of Nursing, Dentistry and Health Sciences, University of Melbourne, Victoria, Australia; Department of Health Services Research, Peter MacCallum Cancer Centre, Victoria, Australia; Victorian Comprehensive Cancer Centre Alliance, Victoria, Australia
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Fethney J, Kim B, Boustany C, McKenzie H, Hayes L, Cox K, Simpson JM, Horvath LG, Vardy JL, McLeod J, Willcock S, Cook N, Acret L, White K. Evaluating a shared care pathway intervention for people receiving chemotherapy to reduce post-treatment unplanned hospital presentations: a randomised controlled trial. Support Care Cancer 2024; 32:77. [PMID: 38170289 PMCID: PMC10764538 DOI: 10.1007/s00520-023-08261-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 12/15/2023] [Indexed: 01/05/2024]
Abstract
PURPOSE The aim of this randomised controlled trial (RCT) was to explore whether a community nursing intervention for outpatients receiving systemic therapy reduced unplanned hospital presentations and improved physical and psychosocial health outcomes over the first three cycles of treatment compared to a control group receiving standard care. METHODS The number of and reasons for unplanned presentations were obtained for 170 intervention and 176 control group adult patients with solid tumours starting outpatient chemotherapy. Poisson regression was used to compare the number of presentations between the intervention and control groups. Patients self-completed the Hospital Anxiety and Depression Scale, the Cancer Behavior Inventory and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire core 30 (EORTC QLQ-C30) at the start of the first four cycles. Linear regression techniques were used to compare quality of life outcomes. RESULTS The reduction in unplanned presentations in the intervention group relative to the control group was 12% (95% CI, - 25%, 37%; P = 0.48). At the start of cycle 4, there was no difference in anxiety (difference = 0.47 (95% CI, - 0.28, 1.22; P = 0.22)), depression (difference = 0.57 (95% CI, - 0.18, 1.31; P = 0.13)) or EORTC QLQ-C30 summary score (difference = 0.16 (95% CI, - 2.67, 3.00; P = 0.91)). Scores for self-efficacy as measured by the Cancer Behavior Inventory were higher in the intervention group (difference = 4.3 (95% CI, 0.7, 7.9; P = 0.02)). CONCLUSION This RCT did not demonstrate a benefit in reducing unplanned presentations to hospital. The trial identified improved cancer-based self-efficacy in patients receiving the intervention. TRIAL REGISTRATION Registered at Australian and New Zealand Clinical Trials Registry: ACTRN12614001113640, registered 21/10/2014.
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Affiliation(s)
- Judith Fethney
- Susan Wakil School of Nursing and Midwifery, The University of Sydney, Sydney, Australia.
| | - Bora Kim
- Susan Wakil School of Nursing and Midwifery, The University of Sydney, Sydney, Australia
- Cancer Care Research Unit, Sydney Local Health District, The University of Sydney, Sydney, Australia
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
| | - Chantale Boustany
- Susan Wakil School of Nursing and Midwifery, The University of Sydney, Sydney, Australia
- Cancer Care Research Unit, Sydney Local Health District, The University of Sydney, Sydney, Australia
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
| | - Heather McKenzie
- Susan Wakil School of Nursing and Midwifery, The University of Sydney, Sydney, Australia
| | - Lillian Hayes
- Susan Wakil School of Nursing and Midwifery, The University of Sydney, Sydney, Australia
| | - Keith Cox
- Chris O'Brien Lifehouse, Sydney, Australia
| | - Judy M Simpson
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Lisa G Horvath
- Chris O'Brien Lifehouse, Sydney, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Janette L Vardy
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Sydney Local Health District, Sydney, Australia
| | - Jodi McLeod
- Sydney District Nursing, Sydney Local Health District, Sydney, Australia
| | - Simon Willcock
- MQ Health, Macquarie University Hospital, Primary Care, Sydney, Australia
| | | | - Louise Acret
- Cancer Care Research Unit, Sydney Local Health District, The University of Sydney, Sydney, Australia
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
| | - Kate White
- Susan Wakil School of Nursing and Midwifery, The University of Sydney, Sydney, Australia
- Cancer Care Research Unit, Sydney Local Health District, The University of Sydney, Sydney, Australia
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
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Lash RS, Hong AS, Bell JF, Reed SC, Pettit N. Recognizing the emergency department’s role in oncologic care: a review of the literature on unplanned acute care. EMERGENCY CANCER CARE 2022; 1:6. [PMID: 35844666 PMCID: PMC9200439 DOI: 10.1186/s44201-022-00007-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 05/08/2022] [Indexed: 11/10/2022]
Abstract
Abstract
Background
The global prevalence of cancer is rapidly increasing and will increase the acute care needs of patients with cancer, including emergency department (ED) care. Patients with cancer present to the ED across the cancer care continuum from diagnosis through treatment, survivorship, and end-of-life. This article describes the characteristics and determinants of ED visits, as well as challenges in the effort to define preventable ED visits in this population.
Findings
The most recent population-based estimates suggest 4% of all ED visits are cancer-related and roughly two thirds of these ED visits result in hospitalization—a 4-fold higher ED hospitalization rate than the general population. Approximately 44% of cancer patients visit the ED within 1 year of diagnosis, and more often have repeat ED visits within a short time frame, though there is substantial variability across cancer types. Similar patterns of cancer-related ED use are observed internationally across a range of different national payment and health system settings. ED use for patients with cancer likely reflects a complex interaction of individual and contextual factors—including provider behavior, health system characteristics, and health policies—that warrants greater attention in the literature.
Conclusions
Given the amount and complexity of cancer care delivered in the emergency setting, future research is recommended to examine specific symptoms associated with cancer-related ED visits, the contextual determinants of ED use, and definitions of preventable ED use specific to patients with cancer.
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Dufton PH, Gerdtz MF, Jarden R, Krishnasamy M. Methodological approaches to measuring the incidence of unplanned emergency department presentations by cancer patients receiving systemic anti-cancer therapy: a systematic review. BMC Med Res Methodol 2022; 22:75. [PMID: 35313807 PMCID: PMC8935762 DOI: 10.1186/s12874-022-01555-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 02/25/2022] [Indexed: 12/24/2022] Open
Abstract
Background The need to mitigate the volume of unplanned emergency department (ED) presentations is a priority for health systems globally. Current evidence on the incidence and risk factors associated with unplanned ED presentations is unclear because of substantial heterogeneity in methods reporting on this issue. The aim of this review was to examine the methodological approaches to measure the incidence of unplanned ED presentations by patients receiving systemic anti-cancer therapy in order to determine the strength of evidence and to inform future research. Methods An electronic search of Medline, Embase, CINAHL, and Cochrane was undertaken. Papers published in English language between 2000 and 2019, and papers that included patients receiving systemic anti-cancer therapy as the denominator during the study period were included. Studies were eligible if they were analytical observational studies. Data relating to the methods used to measure the incidence of ED presentations by patients receiving systemic anti-cancer therapy were extracted and assessed for methodological rigor. Findings are reported in accordance with the Synthesis Without Meta-Analysis (SWiM) guideline. Results Twenty-one articles met the inclusion criteria: 20 cohort studies, and one cross-sectional study. Overall risk of bias was moderate. There was substantial methodological and clinical heterogeneity in the papers included. Methodological rigor varied based on the description of methods such as the period of observation, loss to follow-up, reason for ED presentation and statistical methods to control for time varying events and potential confounders. Conclusions There is considerable diversity in the population and methods used in studies that measure the incidence of unplanned ED presentations by patients receiving systemic anti-cancer therapy. Recommendations to support the development of robust evidence include enrolling participants at diagnosis or initiation of treatment, providing adequate description of regular care to support patients who experience toxicities, reporting reasons for and characteristics of participants who are lost to follow-up throughout the study period, clearly defining the outcome including the observation and follow-up period, and reporting crude numbers of ED presentations and the number of at-risk days to account for variation in the length of treatment protocols. Supplementary Information The online version contains supplementary material available at 10.1186/s12874-022-01555-3.
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Affiliation(s)
- P H Dufton
- Department of Nursing, School of Health Sciences, University of Melbourne, Carlton, VIC, Australia.
| | - M F Gerdtz
- Department of Nursing, School of Health Sciences, University of Melbourne, Carlton, VIC, Australia
| | - R Jarden
- Department of Nursing, School of Health Sciences, University of Melbourne, Carlton, VIC, Australia
| | - M Krishnasamy
- Department of Nursing, School of Health Sciences, University of Melbourne, Carlton, VIC, Australia
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Haugstetter C, Mason R, Sanmugarajah J, Hattingh HL. Evaluation of a new emergency department avoidance model of care, the Cancer Urgent Assessment Clinic, in response to the COVID-19 pandemic. EMERGENCY CANCER CARE 2022; 1:11. [PMID: 36211536 PMCID: PMC9527716 DOI: 10.1186/s44201-022-00011-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 09/05/2022] [Indexed: 11/06/2022]
Abstract
Introduction The Cancer Urgent Assessment Clinic (CUAC) was an emergency department (ED) avoidance/unscheduled model of care implemented in response to the COVID-19 pandemic. The aim was to reduce the risk of COVID-19 exposure and infection by providing an alternative to ED for cancer patients while undergoing anticancer treatments. Methods The clinic incorporated a telephone triage process and face-to-face appointments 8am to 8pm, 7 days per week. CUAC operated between 23 March '20 and 31 July '20, led by a nurse practitioner candidate, oncology registrars, cancer nurse specialists, and overseen by oncology consultants. Evaluation followed a mixed-methods approach through (1) analysis of CUAC patient data, (2) comparison of ED cancer patient presentation data from a previous period (23 March 2019-31 July 2019), and (3) a patient survey. Results In total, 400 patients were telephone triaged via CUAC, with 166 recorded as having avoided ED. There was a reduction in the number of cancer patient admissions to the ED short stay unit during the clinic period compared with the same time-period in 2019: 130 vs. 234, associated with 615 fewer hours. Patient satisfaction was positive particularly regarding ease of access, time to treatment, confidence in assessment and treatment of cancer-related concerns, and likelihood of presenting to hospital when unwell during the pandemic. Discussion While initially being implemented to reduce the risk of COVID-19 exposure, this evaluation demonstrated the CUAC model was an efficient and potentially cost-saving model of care for the management of cancer patients with mild to moderate severity of disease and treatment-related concerns.
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Affiliation(s)
- Corrine Haugstetter
- grid.507967.aCancer, Blood and Respiratory Medicine, Gold Coast Health, Southport, QLD 4215 Australia
| | - Robert Mason
- grid.507967.aCancer, Blood and Respiratory Medicine, Gold Coast Health, Southport, QLD 4215 Australia
| | - Jasotha Sanmugarajah
- grid.507967.aCancer, Blood and Respiratory Medicine, Gold Coast Health, Southport, QLD 4215 Australia
| | - H. Laetitia Hattingh
- grid.507967.aMedical Services, Clinical Governance and Research, Gold Coast Health, Southport, QLD 4215 Australia ,grid.1022.10000 0004 0437 5432School of Pharmacy and Medical Sciences, Griffith University, Southport, QLD 4222 Australia
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Lindsay D, Bates N, Diaz A, Watt K, Callander E. Quantifying the hospital and emergency department costs for women diagnosed with breast cancer in Queensland. Support Care Cancer 2021; 30:2141-2150. [PMID: 34676449 DOI: 10.1007/s00520-021-06570-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 09/10/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE With increasing rates of cancer survival due to advances in screening and treatment options, the costs of breast cancer diagnoses are attracting interest. However, limited research has explored the costs to the Australian healthcare system associated with breast cancer. We aimed to describe the cost to hospital funders for hospital episodes and emergency department (ED) presentations for Queensland women with breast cancer, and whether costs varied by demographic characteristics. METHODS We used a linked administrative dataset, CancerCostMod, limited to all breast cancer diagnoses aged 18 years or over in Queensland between July 2011 and June 2015 (n = 13,285). Each record was linked to Queensland Health Admitted Patient Data Collection and Emergency Department Information Systems records between July 2011 and June 2018. The cost of hospital episodes and ED presentations were determined, with mean costs per patient modelled using generalised linear models with a gamma distribution and log link function. RESULTS The total cost to the Queensland healthcare system from hospital episodes for female breast cancer was AUD$309 million and AUD$12.6 million for ED presentations during the first 3 years following diagnosis. High levels of costs and service use were identified in the first 6 months following diagnosis. Some significant differences in cost of hospital and ED episodes were identified based on demographic characteristics, with Indigenous women and those from lower socioeconomic backgrounds having higher costs. CONCLUSION Hospitalisation costs for breast cancer in Queensland exert a high burden on the healthcare system. Costs are higher for women during the first 6 months from diagnosis and for Indigenous women, as well as those with underlying comorbidities and lower socioeconomic position.
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Affiliation(s)
- Daniel Lindsay
- School of Public Health, The University of Queensland, Brisbane, Australia.
| | - Nicole Bates
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia
| | - Abbey Diaz
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - Kerrianne Watt
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia
| | - Emily Callander
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Button E, Gavin NC, Bates T, Ahmed D, Nasato G, Wyld D, Kennedy G, Fennelly E, Smith M, Northfield S, Yates P. Prospective cohort study of an Australian cancer care services-led model of emergent care. AUST HEALTH REV 2021; 45:613-621. [PMID: 34252361 DOI: 10.1071/ah20346] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 03/25/2021] [Indexed: 11/23/2022]
Abstract
Objective Many cancer care services (CCS) provide pragmatic models of emergent care for their patients as part of 'business as usual' without understanding the scope of this work. We aimed to describe an Australian CCS-led model of emergent care and quantify and profile emergent care provided over a 6-month period to understand scope and demand. Methods This prospective cohort study was performed at a large tertiary hospital on the eastern coast of Australia in 2016. The study explored emergent care provided during business hour and after-hours, including telephone advice, unplanned care and unplanned admissions. Data were collected via electronic hospital records and clinical nurses regarding who accessed care, why care was accessed, what care was provided and how the episode of care ended. Results Between March and September 2016, 1412 episodes of unplanned care were provided in the CCS-led model of care, including 307 episodes of telephone advice (237 patients; min max 1-4 episodes per patient; 825 episodes of unplanned care (484 patients; min max 1-9 episodes per patient) and 280 unplanned admissions (233 patients; min max 1-6 episodes per patient). During the same time, an additional 459 unplanned admissions (361 patients) occurred via the emergency department (ED), of which 125 (27.2%) occurred during business hours which could have been managed by the CCS. Most people who received care experienced issues associated with disease or treatment and had received systemic anticancer therapy in the past 30 days. Conclusions The data demonstrate that a significant volume of emergent care was provided within the CCS over the study period, in addition to planned cancer treatment. Due to the ever-increasing demands on EDs and the significant need for emergent care for people with cancer, there is need for CCS-led models of care to provide specialist emergent care specifically for people who are receiving systemic anticancer therapy. Such models must be adequately resourced to meet the needs of patients, carers and healthcare professionals. What is known about the topic? There is increasing focus on innovative models of emergent care for people with cancer in the out-patient setting to relieve pressure on EDs and improve patient experiences. Limited literature has focused on such models in the Australian context. What does this paper add? This paper describes, quantifies and profiles care provided in a pragmatic CCS-led model of emergent care in a large tertiary hospital in Australia over 6 months. The data demonstrate significant demand for emergent care within business hours, as well as out of hours, predominantly for people undergoing systemic anticancer therapy. What are the implications for practitioners? The findings of this study highlight the need for CCS to develop pragmatic models of emergent care. Appropriate resources, infrastructure, policies and procedures are required to adequate meet the needs of patients and carers.
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Affiliation(s)
- Elise Button
- Cancer Care Services, Level 2, Block 34, Royal Brisbane and Women's Hospital, Bowen Bridge Road, Herston, Qld 4006, Australia
| | - Nicole C Gavin
- Cancer Care Services, Level 2, Block 34, Royal Brisbane and Women's Hospital, Bowen Bridge Road, Herston, Qld 4006, Australia
| | - Tracey Bates
- Cancer Care Services, Level 2, Block 34, Royal Brisbane and Women's Hospital, Bowen Bridge Road, Herston, Qld 4006, Australia
| | - Deka Ahmed
- Mater Hospital Mater Health, Raymond Terrace, Woolloongabba, Qld 4102, Australia
| | - Gillian Nasato
- Cancer Care Services, Level 2, Block 34, Royal Brisbane and Women's Hospital, Bowen Bridge Road, Herston, Qld 4006, Australia
| | - David Wyld
- Cancer Care Services, Level 2, Block 34, Royal Brisbane and Women's Hospital, Bowen Bridge Road, Herston, Qld 4006, Australia
| | - Glen Kennedy
- Cancer Care Services, Level 2, Block 34, Royal Brisbane and Women's Hospital, Bowen Bridge Road, Herston, Qld 4006, Australia
| | - Eileen Fennelly
- Cancer Care Services, Level 2, Block 34, Royal Brisbane and Women's Hospital, Bowen Bridge Road, Herston, Qld 4006, Australia
| | - Michael Smith
- Cancer Care Services, Level 2, Block 34, Royal Brisbane and Women's Hospital, Bowen Bridge Road, Herston, Qld 4006, Australia
| | - Sarah Northfield
- Cancer Care Services, Level 2, Block 34, Royal Brisbane and Women's Hospital, Bowen Bridge Road, Herston, Qld 4006, Australia
| | - Patsy Yates
- Cancer Care Services, Level 2, Block 34, Royal Brisbane and Women's Hospital, Bowen Bridge Road, Herston, Qld 4006, Australia
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Gallaway MS, Idaikkadar N, Tai E, Momin B, Rohan EA, Townsend J, Puckett M, Stewart SL. Emergency department visits among people with cancer: Frequency, symptoms, and characteristics. J Am Coll Emerg Physicians Open 2021; 2:e12438. [PMID: 33969353 PMCID: PMC8087934 DOI: 10.1002/emp2.12438] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 03/16/2021] [Accepted: 03/25/2021] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE People with cancer are increasingly more likely to visit an emergency department for acute care than the general population. They often have long wait times and more exposure to infection and receive treatment from staff less experienced with cancer-related problems. Our objective was to examine emergency department (ED) visits among people with cancer to understand how often and why they seek care. METHODS We conducted a retrospective study of ED visits using the National Syndromic Surveillance Program BioSense Platform. Cancer reported during an ED visit was identified using International Classification of Diseases, Tenth Revision codes for any cancer type, including bladder, breast, cervical, colorectal, kidney, liver, lung, ovary, pancreas, prostate, or uterine cancers. Symptoms prompting the visit were identified for people with cancer who visited EDs in the United States from June 2017 to May 2018 in ≈4500 facilities, including 3000 EDs in 46 states and the District of Columbia (66% of all ED visits during a 1-year period). RESULTS Of 97 million ED visits examined, 710,297 (0.8%) were among people with cancer. Percentages were higher among women (50.1%) than men (49.5%) and among adults aged ≥65 years (53.6%) than among those ≤64 years (45.7%). The most common presenting symptoms were pain (19.1%); gastrointestinal (13.8%), respiratory (11.5%), and neurologic (5.3%) complaints; fever (4.9%); injury (4.1%); and bleeding (2.4%). Symptom prevalence differed significantly by cancer type. CONCLUSIONS The Centers for Medicare & Medicaid Services encourages efforts to reduce acute care visits among people with cancer. We characterized almost 70% of ED visits among this population.
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Affiliation(s)
- Michael Shayne Gallaway
- Division of Cancer Prevention and ControlNational Center for Chronic Disease Prevention and Health PromotionCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Nimi Idaikkadar
- Division of Health Informatics and SurveillanceCenter for SurveillanceEpidemiology, and Laboratory ServicesCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Eric Tai
- Division of Cancer Prevention and ControlNational Center for Chronic Disease Prevention and Health PromotionCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Behnoosh Momin
- Division of Cancer Prevention and ControlNational Center for Chronic Disease Prevention and Health PromotionCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Elizabeth A. Rohan
- Division of Cancer Prevention and ControlNational Center for Chronic Disease Prevention and Health PromotionCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Julie Townsend
- Division of Cancer Prevention and ControlNational Center for Chronic Disease Prevention and Health PromotionCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Mary Puckett
- Division of Cancer Prevention and ControlNational Center for Chronic Disease Prevention and Health PromotionCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Sherri L. Stewart
- Division of Cancer Prevention and ControlNational Center for Chronic Disease Prevention and Health PromotionCenters for Disease Control and PreventionAtlantaGeorgiaUSA
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Peyrony O, Fontaine JP, Trabattoni E, Nakad L, Charreyre S, Picaud A, Bosc J, Viglino D, Jacquin L, Laribi S, Pereira L, Thiriez S, Paquet AL, Tanneau A, Azoulay E, Chevret S. Cancer Patients' Prehospital Emergency Care: Post Hoc Analysis from the French Prospective Multicenter Study EPICANCER. J Clin Med 2021; 10:jcm10051145. [PMID: 33803366 PMCID: PMC7967166 DOI: 10.3390/jcm10051145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/03/2021] [Accepted: 03/05/2021] [Indexed: 12/03/2022] Open
Abstract
Background: Very little data are available concerning the prehospital emergency care of cancer patients. The objective of this study is to report the trajectories and outcomes of cancer patients attended by prehospital emergency services. Methods: This was an ancillary study from a three-day cross-sectional prospective multicenter study in France. Adult patients with cancer were included if they called the emergency medical dispatch center Service d’Aide Médicale Urgente (SAMU). The study was registered on ClinicalTrials.gov (NCT03393260, accessed on 8th January 2018). Results: During the study period, 1081 cancer patients called the SAMU. The three most frequent reasons were dyspnea (20.2%), neurological disorder (15.4%), and fatigue (13.1%). Among those patients, 949 (87.8%) were directed to the hospital, among which 802 (90.8%) were directed to an emergency department (ED) and 44 (5%) were transported directly to an intensive care unit (ICU). A mobile intensive care unit (MICU) was dispatched 213 (31.6%) times. The decision to dispatch an MICU seemed generally based on the patient’s reason for seeking emergency care and the presence of severity signs rather than on the malignancy or the patient general health status. Among the patients who were directed to the ED, 98 (16.1%) were deceased on day 30. Mortality was 15.4% for those patients directed to the ED but who were not admitted to the ICU in the next 7 days, 28.2% for those who were admitted to ICU in the next 7 days, and 56.1% for those patients transported by the MICU directly to the ICU. Conclusion: Cancer patients attending prehospital emergency care were most often directed to EDs. Patients who were directly transported to the ICU had a high mortality rate, raising the question of improving triage policies.
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Affiliation(s)
- Olivier Peyrony
- Emergency Department, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris, 75010 Paris, France;
- Correspondence: ; Tel.: +33-1-4249-8404
| | - Jean-Paul Fontaine
- Emergency Department, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris, 75010 Paris, France;
| | | | - Lionel Nakad
- Emergency Department, Henri Mondor University Hospital, Assistance Publique-Hôpitaux de Paris, 94000 Créteil, France;
| | - Sylvain Charreyre
- Emergency Department, SAMU de Lyon, Edouard Herriot University Hospital, 69622 Lyon, France;
- University Claude Bernard Lyon 1, 69007 Lyon, France
| | - Adrien Picaud
- Emergency Department, SAMU, SMUR. Le Mans Hospital, 72181 Le Mans, France;
| | - Juliane Bosc
- Emergency Department, SMUR. Libourne and Sainte Foy la Grande Hospital, 33243 Libourne, France;
| | - Damien Viglino
- Emergency Department, Grenoble-Alpes University Hospital, 38043 Grenoble, France;
- HP2 INSERM U 1042 University Grenoble-Alpes, 38043 Grenoble, France
| | - Laurent Jacquin
- Emergency Department, Hospices Civils de Lyon, Edouard Herriot University Hospital, 69622 Lyon, France;
| | - Saïd Laribi
- Emergency Department, Tours University Hospital, 37000 Tours, France;
| | - Laurent Pereira
- Emergency Department, Bichat University Hospital, Assistance Publique-Hôpitaux de Paris, 75018 Paris, France;
| | - Sylvain Thiriez
- Emergency Department, SMUR, Victor Provo Hospital, Roubaix Hospital, 59100 Roubaix, France;
| | - Anne-Laure Paquet
- Emergency Department, la Pitié-Salpêtrière University Hospital, Assistance Publique-Hôpitaux de Paris, 75013 Paris, France;
- Sorbonne-UPMC-Paris VI University, 75005 Paris, France
| | - Alexandre Tanneau
- Emergency Department, SMUR of Lorient and Quimperlé, Bretagne Sud Hospital Group, 56322 Lorient, France;
| | - Elie Azoulay
- Intensive Care Unit, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris, 75010 Paris, France;
- Centre of Research in Epidemiology and StatisticS (CRESS), INSERM, UMR 1153, Epidemiology and Clinical Statistics for Tumor, Respiratory, and Resuscitation Assessments (ECSTRRA) Team, University of Paris, 75006 Paris, France;
| | - Sylvie Chevret
- Centre of Research in Epidemiology and StatisticS (CRESS), INSERM, UMR 1153, Epidemiology and Clinical Statistics for Tumor, Respiratory, and Resuscitation Assessments (ECSTRRA) Team, University of Paris, 75006 Paris, France;
- Department of Biostatistics and Medical Information, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris, 75010 Paris, France
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Oğuz G, Koçak N, Şenel G, Kadioğullari N. Characteristics of Advanced Cancer Patients Admitted to the Palliative Care Unit from the Emergency Department. Indian J Palliat Care 2021; 27:89-94. [PMID: 34035623 PMCID: PMC8121232 DOI: 10.4103/ijpc.ijpc_126_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 07/01/2020] [Accepted: 10/02/2020] [Indexed: 11/05/2022] Open
Abstract
Aim: People with cancer frequently present to emergency departments (EDs) because of exacerbation of the existing problems and new symptoms, complications of treatments, or difficulties with care and support systems. The aim of the study was to determine the presenting symptoms and demographic characteristics of advanced cancer patients and their caregivers admitted to the palliative care (PC) unit from the ED. Methods: After approval, 139 cancer patients admitted to the ED and referred for PC consultation were included in the study. The medical records of PC unit for all patients and their primary caregivers were retrospectively evaluated. Demographic characteristics, cancer site and metastasis, reasons and frequency for ED admissions, symptoms, duration of hospitalization, and outcomes were recorded. The association between the characteristics of caregivers and emergency visits was also evaluated. Results: Among all patients, 61.9% were >60 years old, 58.3% were male, and 71.2% were married. The most frequent site of cancer was gastrointestinal system (39.6%), lungs (18.7%), and genitourinary system (12.2%). The reasons for emergency visits were found as inadequate symptom control (65.5%), dying patient (30.2%), lack of psychosocial support (3.6%), and symptom of other comorbidities (0.7%). The most frequent symptoms were feeling of not well-being, tiredness, and lack of appetite. There was no difference in the number of admissions according to caregivers. Ninety-seven patients (69.8%) died at the PC unit and 42 (30.2%) were discharged. Conclusion: PC system needs to be integrated into all health-care disciplines including EDs. While improving a community- and home-based PC, education of patients, caregivers, and health professionals must also be provided.
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Affiliation(s)
- Gonca Oğuz
- Department of Anesthesiology, Palliative Care Unit, University of Health Sciences, Dr. AY Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - Nesteren Koçak
- Department of Anesthesiology, Palliative Care Unit, University of Health Sciences, Dr. AY Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - Gülçin Şenel
- Department of Anesthesiology, Palliative Care Unit, University of Health Sciences, Dr. AY Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - Nihal Kadioğullari
- Department of Anesthesiology, Palliative Care Unit, University of Health Sciences, Dr. AY Ankara Oncology Training and Research Hospital, Ankara, Turkey
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Torigoe T, Imanishi J, Yazawa Y, Koyama T, Kadono Y, Oda H, Saita K. Oncologic emergency in patients with skeletal metastasis of unknown primary. Acute Med Surg 2021; 8:e600. [PMID: 33552525 PMCID: PMC7860590 DOI: 10.1002/ams2.600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 10/15/2020] [Accepted: 10/16/2020] [Indexed: 11/17/2022] Open
Abstract
Aim Patients with skeletal metastasis from prediagnosed primary malignancy sometimes have concurrent oncologic emergency (OE) during the first visit. This study aims to investigate the types of OEs and treatment outcome in such patients. Methods We have experienced 359 patients with skeletal metastasis from unknown primary malignancy. Among them, 130 patients required immediate admission for OE treatment (OE group), 229 patients had no OE and did not required immediate admission (non‐OE group). Results The recognized types of OE were spinal cord compression in 60 patients, cancer pain in 30, hypercalcemia in 19, delirium in 16, deep vein thrombosis in 13, acute renal failure in 6, respiratory failure in 3, gastrointestinal hemorrhage in 3, and disseminated intravascular coagulation in 1. The overall 5‐year survival rates were 28% and 37% in the OE and non‐OE groups, respectively (P < 0.001). The multivariate analysis revealed that delirium (hazard ratio 4.2; 95% confidence interval, 1.6–12.5; P < 0.005) and respiratory failure (hazard ratio 22.6; 95% confidence interval, 4.5–92.8; P < 0.001) were significant prognostic factors in patients with OEs, whereas other OEs did not confer a significant risk for patient outcomes. Conclusion In this study, OE was observed in as many as 36% of patients with skeletal metastasis from unknown primary malignancy. Delirium and respiratory failure were only two significant prognostic risk factors, which suggest that many of the OEs in untreated advanced cancer patients have probable chance to resolve. Early detection followed by appropriate treatment of such OEs is recommended.
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Affiliation(s)
- Tomoaki Torigoe
- Department of Orthopedic Oncology and Surgery Saitama Medical University International Medical Center Hidaka Japan
| | - Jungo Imanishi
- Department of Orthopedic Oncology and Surgery Saitama Medical University International Medical Center Hidaka Japan
| | - Yasuo Yazawa
- Department of Orthopedic Oncology and Surgery Saitama Medical University International Medical Center Hidaka Japan
| | - Tadaaki Koyama
- Division of Orthopedic Oncology Shizuoka Cancer Center Hospital Nagaizumi Japan
| | - Yuho Kadono
- Department of Orthopedic Surgery Saitama Medical University Moroyama Japan
| | - Hiromi Oda
- Department of Orthopedic Surgery Saitama Medical University Moroyama Japan
| | - Kazuo Saita
- Department of Orthopedic Surgery Saitama Medical Center Saitama Medical University Kawagoe Japan
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Shih STF, Mellerick A, Akers G, Whitfield K, Moodie M. Economic Assessment of a New Model of Care to Support Patients With Cancer Experiencing Cancer- and Treatment-Related Toxicities. JCO Oncol Pract 2020; 16:e884-e892. [DOI: 10.1200/jop.19.00702] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
PURPOSE: The aim of this economic assessment was to evaluate the impact of a new nurse-led model of care, the Symptom and Urgent Review Clinic (SURC), for patients with cancer experiencing disease- or treatment-related symptoms. METHODS: An economic assessment was undertaken to estimate costs of the SURC from the service funder perspective and to compare the cost with cost offsets stemming from the implementation of the SURC. The cost offsets focused on the changes in emergency department (ED) presentations and inpatient admissions during a comparable 6-month period before and after the SURC implementation. Costs were analyzed in 2018 Australian dollars, and return on investment was calculated by comparing the cost offsets in the ED and inpatient units with the cost of the SURC. RESULTS: After the implementation of the SURC, patients were less likely to present to the ED (7.2% v 8.5%; P = .01), and patients who did present to the ED were more likely to be admitted to inpatient units (78% v 71%; P = .03) for additional treatment. The post-SURC period had a net cost savings of $37,090 compared with the pre-SURC period. From the service funder perspective, the SURC achieved an investment return of $1.73 for every dollar invested in the new service. CONCLUSION: Our study establishes the economic credentials of a new care model using empirical linked hospital service data. The SURC presents a new cancer care service for policy consideration from an economic standpoint. It demonstrates an efficient approach to hospital resource allocation to deliver quality cancer care.
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Affiliation(s)
- Sophy T. F. Shih
- Deakin Health Economics, Institute of Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Angela Mellerick
- Ambulatory Cancer Services, Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, Heidelberg, Victoria, Australia
| | - Georgina Akers
- Health & Wellbeing Division, Department of Health & Human Services, Melbourne, Victoria, Australia
| | - Kathryn Whitfield
- Health & Wellbeing Division, Department of Health & Human Services, Melbourne, Victoria, Australia
| | - Marj Moodie
- Deakin Health Economics, Institute of Health Transformation, Deakin University, Geelong, Victoria, Australia
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Buyan RC, Aylott J, Carratt D. Improving an acute oncology service (AOS) through collaborative leadership. Leadersh Health Serv (Bradf Engl) 2020. [DOI: 10.1108/lhs-12-2019-0078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Over half of adults under the age of 65 years will be diagnosed with cancer at some point in their lives (Ahmad et al., 2015). Demand for services is outstripping the capacity in the NHS, as 77% of NHS Trusts are unable to start treatment within 62 days (Baker, 2019; NHS England, 2019). Side effects of treatment can be life threatening (Tsai et al., 2010) with many patients attending ED; however, these can be managed through a hospital’s Acute Oncology Service (AOS). This paper aims to explore a collaborative leadership approach to improve services for patients [Rubin et al., 2015; Department of Health (DOH), 2012].
Design/methodology/approach
A case study of an AOS in an NHS Trust was the focus for the development of a strategy of ‘Collaborative’ leadership, with the aim to increase the engagement of a wide network of clinical and non-clinical stakeholders in a review of the AOS. The case study identified the level of effectiveness of the service since its inception in 2012. Using a quality improvement methodology (Deming 2000; Health Foundation, 2011; Aylott, 2019) resulted in learning and increased collaboration between clinical and non-clinical staff.
Findings
Action learning processes revealed that AOS staff had been frustrated for some time about the dysfunction of the current process to manage the increased demand for the service. They reported their perceptions and frustrations with the current process of referral and patient discharge. Data revealed alerts from the Emergency Department (ED) to AOS resulted in 72% of patients inappropriately referred, with an over representation of patients who had a previous existing cancer condition. Clinical engagement with the data informatics manager (DC) revealed a need to improve data quality through improvements made to the database.
Research limitations/implications
Increasing demand for cancer services requires a continuous need for improvement to meet patient needs. Cancer waits for diagnostic tests are at their highest level since 2008, with 4% of patients waiting over 6 weeks to be tested compared to the tested target of 1% (Baker, 2019). This paper draws on data collected from 2017 to 2018, but a continuous review of data is required to measure the performance of the AOS against its service specification. Every AOS team across the NHS could benefit from a collaborative learning approach.
Practical implications
Clinical services need collaborative support from informatics to implement a Quality Improvement methodology such as the IHI Model for Improvement (IHI, 2003). Without collaboration the implementation of a quality improvement strategy for all NHS Trusts will not come to fruition (Kings Fund, 2016). Quality Improvement Strategies must be developed with a collaborative leadership implementation plan that includes patient collaboration strategies (Okpala, 2018), as this is the only way that services will be improved while also becoming cost effective (Okpala, 2018).
Social implications
In the UK, 20-25% of new cancer diagnoses are made following an initial presentation to the ED (Young et al., 2016). Cancer-related attendances at ED had a higher level of acuity, requiring longer management time and length of stay in ED. With cancer care contributing to 12% of all hospital admissions, an increase of 25% over the past two decades (Kuo et al., 2017) the AOS will need continued collaboration between clinical staff, informatic managers, patients and all stakeholder organisations to continuously improve its services to be “fit for purpose”.
Originality/value
This case study reports the innovative collaborative work between a Medical Oncologist, an NHS Trust Informatics manager and a QI academic facilitator. The Health Foundation and Kings Fund have identified the continued challenges presented to the NHS in the transformation of its services, with the Health Foundation (2011) reporting the need for more collaborative working between clinicians and non-clinicians to drive improvement. This model of collaboration creates a new way of working to drive improvement initiatives and sets out a rationale to develop this model further to involve patients. However, this will call for a new way of working for all.
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Peyrony O, Fontaine JP, Beaune S, Khoury A, Truchot J, Balen F, Vally R, Schmitt J, Ben Hammouda K, Roussel M, Borzymowski C, Vallot C, Sanh V, Azoulay E, Chevret S. EPICANCER-Cancer Patients Presenting to the Emergency Departments in France: A Prospective Nationwide Study. J Clin Med 2020; 9:jcm9051505. [PMID: 32429507 PMCID: PMC7291158 DOI: 10.3390/jcm9051505] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/12/2020] [Accepted: 05/14/2020] [Indexed: 01/20/2023] Open
Abstract
Background: We aimed to estimate the prevalence of cancer patients who presented to Emergency Departments (EDs), report their chief complaint and identify the predictors of 30-day all-cause mortality. Patients and methods: we undertook a prospective, cross-sectional study during three consecutive days in 138 EDs and performed a logistic regression to identify the predictors of 30-day mortality in hospitalized patients. Results: A total of 1380 cancer patients were included. The prevalence of cancer patients among ED patients was 2.8%. The most frequent reasons patients sought ED care were fatigue (16.6%), dyspnea (16.3%), gastro-intestinal disorders (15.1%), trauma (13.0%), fever (12.5%) and neurological disorders (12.5%). Patients were admitted to the hospital in 64.9% of cases, of which 13.4% died at day 30. Variables independently associated with a higher mortality at day 30 were male gender (Odds Ratio (OR), 1.63; 95% CI, 1.04–2.56), fatigue (OR, 1.65; 95% CI, 1.01–2.67), poor performance status (OR, 3.00; 95% CI, 1.87–4.80), solid malignancy (OR, 3.05; 95% CI, 1.26–7.40), uncontrolled malignancy (OR, 2.27; 95% CI, 1.36–3.80), ED attendance for a neurological disorder (OR, 2.38; 95% CI, 1.36–4.19), high shock-index (OR, 1.80; 95% CI, 1.03–3.13) and oxygen therapy (OR, 2.68; 95% CI, 1.68–4.29). Conclusion: Cancer patients showed heterogeneity among their reasons for ED attendance and a high need for hospitalization and case fatality. Malignancy and general health status played a major role in the patient outcomes. This study suggests that the emergency care of cancer patients may be complex. Thus, studies to assess the impact of a dedicated oncology curriculum for ED physicians are warranted.
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Affiliation(s)
- Olivier Peyrony
- Department of Emergency Medicine, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris, 1 avenue Claude Vellefaux, 75010 Paris, France;
- Correspondence: ; Tel.: +33-1-42-49-84-04
| | - Jean-Paul Fontaine
- Department of Emergency Medicine, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris, 1 avenue Claude Vellefaux, 75010 Paris, France;
| | - Sébastien Beaune
- Department of Emergency Medicine, Ambroise Paré University Hospital, Assistance Publique-Hôpitaux de Paris, 92100 Boulogne-Billancourt, France;
- INSERM UMRS 1144, Paris-Descartes University, 75006 Paris, France
- Initiatives de Recherche aux Urgences (IRU) Research Network, Société Française de Médecine d’Urgence (SFMU), 75010 Paris, France; (A.K.); (J.T.)
| | - Abdo Khoury
- Initiatives de Recherche aux Urgences (IRU) Research Network, Société Française de Médecine d’Urgence (SFMU), 75010 Paris, France; (A.K.); (J.T.)
- Department of Emergency Medicine & Critical Care, Besançon University Hospital, 25000 Besançon, France
| | - Jennifer Truchot
- Initiatives de Recherche aux Urgences (IRU) Research Network, Société Française de Médecine d’Urgence (SFMU), 75010 Paris, France; (A.K.); (J.T.)
- Department of Emergency Medicine, SMUR, Lariboisière University Hospital, Assistance Publique-Hôpitaux de Paris, 75010 Paris, France
- Faculty of Medicine, Paris Diderot University, 75010 Paris, France
| | - Frédéric Balen
- Department of Emergency Medicine, Toulouse University Hospital, 31059 Toulouse, France;
- Faculty of Medicine, Toulouse III—Paul Sabatier University, 31330 Toulouse, France
| | - Rishad Vally
- Department of Emergency Medicine, SAMU 33, Pellegrin University Hospital, 33000 Bordeaux, France;
| | - Jacques Schmitt
- Department of Emergency Medicine, SAMU 68, Mulhouse Hospital, 68100 Mulhouse, France;
| | | | - Mélanie Roussel
- Department of Emergency Medicine, Rouen University Hospital, F-76031 Rouen, France;
| | - Céline Borzymowski
- Department of Emergency Médicine, Jean Bernard Hospital, 59322 Valenciennes, France;
| | - Cécile Vallot
- Department of Emergency Medicine, Annecy Genevois Hospital, 74370 Annecy, France;
| | - Veronique Sanh
- Department of Emergency Medicine, SAMU 95, René Dubos Hospital, 95300 Pontoise, France;
| | - Elie Azoulay
- Intensive Care Unit, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris, 75010 Paris, France;
- Centre of Research in Epidemiology and StatisticS (CRESS), INSERM, UMR 1153, Epidemiology and Clinical Statistics for Tumor, Respiratory, and Resuscitation Assessments (ECSTRRA) Team. University of Paris, 75010 Paris, France;
| | - Sylvie Chevret
- Centre of Research in Epidemiology and StatisticS (CRESS), INSERM, UMR 1153, Epidemiology and Clinical Statistics for Tumor, Respiratory, and Resuscitation Assessments (ECSTRRA) Team. University of Paris, 75010 Paris, France;
- Department of Biostatistics and Medical Information, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris, 75004 Paris, France
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Alsharawneh A, Maddigan J, Gaudine A, Etchegary H, Gao Z. The Quality of Care in the Emergency Management of Cancer Patients With Febrile Neutropenia: A Records-Based Cohort. J Emerg Nurs 2020; 46:468-477. [PMID: 32340736 DOI: 10.1016/j.jen.2020.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 01/04/2020] [Accepted: 03/13/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Febrile neutropenia is one of the most severe oncological emergencies associated with the treatment of cancer. Patients with febrile neutropenia are at grave risk of developing life-threatening sepsis unless there is rapid initiation of treatment. The aim of this study was to evaluate the quality of ED care of patients with febrile neutropenia using the 3 quality dimensions of safety, effectiveness, and timeliness of care. METHODS A retrospective review of all available records of adult cancer patients with febrile neutropenia who presented to 1 urban emergency department in Atlantic Canada was conducted over 5 years. RESULTS Examining the 9 quality indicators of the 431 patients included in the study identified areas for improvement in each of the 3 dimensions. More than one third of the participants were unsafely discharged from the emergency department despite the severity of their conditions. Patients in the study were not seen promptly by the physician and did not receive timely treatment during different phases of their visit. Most importantly, the delay in antibiotic administration presented a major risk for this population. DISCUSSION Aspects of care provided to this cohort of febrile neutropenia patients were inconsistent with the recommended evidence. Strengthening ED care is necessary to reduce the gap between evidence-based and actual care. Quality initiatives can be implemented to improve care to become safer, effective, and timely. Nurses who are in direct contact with the patients and who are actively involved in every single process of the health care system are well positioned to lead this change.
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Chen B, Kanaan C, Jaiyesimi I, Ezekwudo D, Swor R. Clinical Characteristics of Patients with Cancer Presenting to the Emergency Department and Their Use of Emergency Medical Service Transport. PREHOSP EMERG CARE 2020; 24:813-821. [PMID: 31961753 DOI: 10.1080/10903127.2020.1718258] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objectives: Although life-threatening emergencies for cancer patients are relatively rare, cancer patients often seek care in the emergency department. The use of emergency medical service (EMS) by these patients is not well studied. The aim of this study was to investigate the characteristics of cancer patients who present to the emergency department (ED) for care and compare characteristics of patients transported by EMS vs. those transported by private vehicle. Methods: Our retrospective cohort study was conducted in an EMS system with 21,070 annual transports and an academic ED with 129,263 annual visits. Our study consisted of patients with a new diagnosis of cancer between January 1 and July 1, 2015 who subsequently presented to the ED between January 1, 2015 and July 1, 2017. Study variables included patient demographics, mode of ED arrival, cancer type and treatment, patient clinical characteristics, and disposition. To describe differences in patient characteristics of EMS vs. private vehicle transport, we report variable frequencies and stratified them by mode of transport. Results: Of the 2,727 patients with a new diagnosis of cancer, 1,303 (47.8%) presented to the ED with a total of 3,590 visits in 30 months. EMS transported 22% of cancer patients to the ED vs. 78% transported by private vehicle. Thus, cancer patients would make up approximately 1.5% (781/52,675) of all EMS transports during the study period. For those transported by EMS, the most common chief complaints were respiratory distress (16.0%), pain (15.4%), and neurological symptoms (12.6%). Patients with cancer of the lung/respiratory tract (21.5%), upper GI (12.4%), and central nervous system (CNS) (11.0%) were most frequently transported by EMS. Older age, presence of CNS cancer, presentation with neurological or cardiovascular complaints, and higher acuity were significantly associated with EMS transport to ED, while gender and pain severity were not. Patients transported by EMS were more likely to be hospitalized and for greater than 2 days (p < 0.0001). Conclusions: Cancer patients frequently seek emergency care after initial diagnosis, most commonly present for symptom relief, and are often admitted. Patients transported by EMS are more likely to be admitted and for longer periods of time.
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Ng HS, Koczwara B, Roder D, Chan RJ, Vitry A. Patterns of health service utilisation among the Australian population with cancer compared with the general population. AUST HEALTH REV 2019; 44:470-479. [PMID: 31693479 DOI: 10.1071/ah18184] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Accepted: 05/09/2019] [Indexed: 01/19/2023]
Abstract
Objective The aim of this study was to describe patterns of health service utilisation among the Australian population with cancer compared with the general population. Methods Data for all respondents aged ≥25 years from two successive National Health Surveys conducted between 2011 and 2014 were analysed. Respondents with a history of cancer were identified as the cancer group, whereas all other respondents who did not report having had a cancer were included in the non-cancer control group. Comparisons were made between the two groups using logistic regression models. Results The population with cancer was more likely to report having consulted their general practitioner, specialist, chemist, dietician, naturopath, nurse, optometrist, dentist, audiologist and other health professionals than the non-cancer population. The cancer population was also more likely to be admitted to hospital and to have visited an out-patient clinic, emergency department and day clinic. The presence of comorbidity and a current cancer were associated with a greater likelihood of receiving health services among the population with cancer. Conclusion The population with cancer used health services significantly more than the non-cancer population. Further studies are urgently needed to identify optimal approaches to delivery of care for this population, including barriers and enablers for their implementation. What is known about the topic? Multimorbidity is highly prevalent among the cancer population due to risk factors shared between cancer and other chronic diseases, and the development of new conditions resulting from cancer treatment and cancer complications. However, the Australian healthcare system is not set up optimally to address issues related to multimorbidity. What does this paper add? This study is the first step in quantifying health services use by the population with cancer compared with the general population without cancer. Cancer survivors have an increased need for specific health services, particularly among those with multimorbidity. What are the implications for practitioners? The development of integrated care models to manage multiple chronic diseases aligned with the Australian National Strategic Framework for Chronic Conditions is warranted. Further studies are urgently needed to identify optimal approaches to delivery of care for this population, including barriers and enablers for their implementation.
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Affiliation(s)
- Huah Shin Ng
- School of Pharmacy and Medical Sciences, University of South Australia, GPO Box 2471, Adelaide, SA 5001, Australia. ; and Corresponding author.
| | - Bogda Koczwara
- Flinders Centre for Innovation in Cancer, Flinders University, Adelaide, SA 5042, Australia.
| | - David Roder
- Cancer Epidemiology and Population Health, Cancer Research Institute, School of Health Sciences, University of South Australia, Adelaide, SA 5000, Australia.
| | - Raymond Javan Chan
- Princess Alexandra Hospital, Metro South Health, Brisbane, Qld 4102, Australia. ; and School of Nursing, Queensland University of Technology, Brisbane, Qld 4000, Australia
| | - Agnes Vitry
- School of Pharmacy and Medical Sciences, University of South Australia, GPO Box 2471, Adelaide, SA 5001, Australia.
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Dufton PH, Drosdowsky A, Gerdtz MF, Krishnasamy M. Socio-demographic and disease related characteristics associated with unplanned emergency department visits by cancer patients: a retrospective cohort study. BMC Health Serv Res 2019; 19:647. [PMID: 31492185 PMCID: PMC6731557 DOI: 10.1186/s12913-019-4509-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Accepted: 09/03/2019] [Indexed: 01/31/2023] Open
Abstract
Background Emergency department (ED) presentations made by patients having cancer treatment are associated with worth outcomes. This study aimed to explore the socio-demographic and disease related characteristics associated with ED presentation, frequent ED presentations, and place of discharge for cancer patients receiving systemic cancer therapies in the ambulatory setting. Methods This was a single site, retrospective observational cohort design. Hospital data for patients treated in the Day Oncology Unit of a large public tertiary hospital in Melbourne, Australia between December 2014 and November 2017 were extracted from clinical databases and retrospectively matched to ED attendance records. Andersen’s Behavioral Model of Health Service Utilisation provided the conceptual framework for exploring associations between socio-demographic and disease characteristics and ED use. Results A total of 2638 individuals were treated in the Day Oncology Unit over the study dates. Of these, 1182 (45%) made an unplanned ED presentation within 28 days of receiving systemic cancer therapy. One hundred and twenty-two (12%) patients attended the ED on two or more occasions within 28 days; while 112 (10%) patients attended the ED four or more times (within 28 days of receiving systemic cancer therapy) within any given 12 month period. Being born outside of Australia was independently related to making an unplanned ED presentation within 28 days of receiving anti-cancer therapy (p < .01) as was being diagnosed with head and neck (p = .03), upper gastrointestinal (p < .001), colorectal (p < .001), lung (p < .001), skin (p < .001) or breast cancer (p = .01). Conclusions This study identified a subgroup of cancer patients for whom an ED presentation is more likely. Better understanding of socio-demographic and disease related characteristics associated with the risk of an ED presentation may help inform targeted follow up of patients, to mitigate potentially avoidable ED presentation and optimize outcomes of care.
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Affiliation(s)
- Polly H Dufton
- Department of Nursing & Centre for Cancer Research, The University of Melbourne, Parkville, VIC, Australia. .,The Olivia Newton John Cancer, Wellness and Research Centre, Heidelberg, VIC, Australia.
| | - Allison Drosdowsky
- Department of Cancer Experiences Research, Sir Peter McCallum Cancer Centre, Parkville, VIC, Australia
| | - Marie F Gerdtz
- Department of Nursing & Centre for Cancer Research, The University of Melbourne, Parkville, VIC, Australia
| | - Mei Krishnasamy
- Department of Nursing & Centre for Cancer Research, The University of Melbourne, Parkville, VIC, Australia.,The Olivia Newton John Cancer, Wellness and Research Centre, Heidelberg, VIC, Australia.,Victorian Comprehensive Cancer Centre, Parkville, VIC, Australia
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Casanovas Blanco M. Critical review of emergency department management of chemotherapy complications in cancer patients. Eur J Cancer Care (Engl) 2018; 28:e12974. [PMID: 30520179 DOI: 10.1111/ecc.12974] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Revised: 07/10/2018] [Accepted: 10/21/2018] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Recent worldwide advances in cancer therapies have resulted in an increased number of people receiving chemotherapy in ambulatory care settings. In Spain, emergency departments are the single point of entry to acute inpatient services and they play a pivotal role in the management of chemotherapy complications. Little research exists in patterns of emergency department utilisation by oncology patients with chemotherapy-related complications. However, it is important for the oncology patients and the healthcare system to gain understanding in the disease pathway and the organisational factors influencing the quality of care. METHODS This critical review's main aims were to describe the clinical characteristics of patients who presented to an emergency department after chemotherapy treatment as reported in international literature; to map reported patterns of care in emergency department access; and quality of care exploring the management of febrile neutropenic patients described in the literature, against best practice guidelines. RESULTS The search strategy yield 701 articles from MEDLINE, TROVE and SCOPUS and 26 were included. The review combines systematic reviews, observational, cross-sectional case-control studies and randomised control trials. CONCLUSION All articles showed areas and opportunities for improvement in the management of this population, especially with regard to time from triage to antibiotic administration in febrile neutropenic patients.
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Chambers S, Healy H, Hoy WE, Kark A, Ratanjee S, Mitchell G, Douglas C, Yates P, Bonner A. Health service utilisation during the last year of life: a prospective, longitudinal study of the pathways of patients with chronic kidney disease stages 3-5. BMC Palliat Care 2018; 17:57. [PMID: 29622009 PMCID: PMC5887240 DOI: 10.1186/s12904-018-0310-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 03/21/2018] [Indexed: 12/22/2022] Open
Abstract
Background Chronic kidney disease (CKD) is a growing global problem affecting around 10% of many countries’ populations. Providing appropriate palliative care services (PCS) to those with advanced kidney disease is becoming paramount. Palliative/supportive care alongside usual CKD clinical treatment is gaining acceptance in nephrology services although the collaboration with and use of PCS is not consistent. Methods The goal of this study was to track and quantify the health service utilisation of people with CKD stages 3-5 over the last 12 months of life. Patients were recruited from a kidney health service (Queensland, Australia) for this prospective, longitudinal study. Data were collected for 12 months (or until death, whichever was sooner) during 2015-17 from administrative health sources. Emergency department presentations (EDP) and inpatient admissions (IPA) (collectively referred to as critical events) were reviewed by two Nephrologists to gauge if the events were avoidable. Results Participants (n = 19) with a median age of 78 years (range 42-90), were mostly male (63%), 79% had CKD stage 5, and were heavy users of health services during the study period. Fifteen patients (79%) collectively recorded 44 EDP; 61% occurred after-hours, 91% were triaged as imminently and potentially life-threatening and 73% were admitted. Seventy-four IPA were collectively recorded across 16 patients (84%); 14% occurred on weekends or public holidays. Median length of stay was 3 days (range 1-29). The median number of EDP and IPA per patient was 1 and 2 (range 0-12 and 0-20) respectively. The most common trigger to both EDP (30%) and IPA (15%) was respiratory distress. By study end 37% of patients died, 63% were known to PCS and 11% rejected a referral to a PCS. All critical events were deemed unavoidable. Conclusions Few patients avoided using acute health care services in a 12 month period, highlighting the high service needs of this cohort throughout the long, slow decline of CKD. Proactive end-of-life care earlier in the disease trajectory through integrating renal and palliative care teams may avoid acute presentations to hospital through better symptom management and planned care pathways.
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Affiliation(s)
- Shirley Chambers
- Faculty of Health, Queensland University of Technology, Brisbane, Australia. .,National Health and Medical Research Council, Centre for Research Excellence in End of Life Care, Brisbane, Australia.
| | - Helen Healy
- Kidney Health Service, Metro North Hospital and Health Service, Queensland Health, Brisbane, Australia.,National Health and Medical Research Council, Chronic Kidney Disease Centre for Research Excellence, Brisbane, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Wendy E Hoy
- National Health and Medical Research Council, Chronic Kidney Disease Centre for Research Excellence, Brisbane, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Adrian Kark
- Kidney Health Service, Metro North Hospital and Health Service, Queensland Health, Brisbane, Australia
| | - Sharad Ratanjee
- Kidney Health Service, Metro North Hospital and Health Service, Queensland Health, Brisbane, Australia
| | - Geoffrey Mitchell
- National Health and Medical Research Council, Centre for Research Excellence in End of Life Care, Brisbane, Australia.,National Health and Medical Research Council, Chronic Kidney Disease Centre for Research Excellence, Brisbane, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Carol Douglas
- Palliative Care Service, Royal Brisbane and Women's Hospital, Queensland Health, Brisbane, Australia
| | - Patsy Yates
- Faculty of Health, Queensland University of Technology, Brisbane, Australia.,National Health and Medical Research Council, Centre for Research Excellence in End of Life Care, Brisbane, Australia.,Centre for Palliative Care Research and Education, Queensland Health, Brisbane, Australia
| | - Ann Bonner
- Faculty of Health, Queensland University of Technology, Brisbane, Australia.,National Health and Medical Research Council, Centre for Research Excellence in End of Life Care, Brisbane, Australia.,Kidney Health Service, Metro North Hospital and Health Service, Queensland Health, Brisbane, Australia.,National Health and Medical Research Council, Chronic Kidney Disease Centre for Research Excellence, Brisbane, Australia
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Philip J, Remedios C, Breen S, Weiland T, Willenberg L, Boughey M, Jelinek G, Lane H, Marck C, Weil J. The experiences of patients with advanced cancer and caregivers presenting to Emergency Departments: A qualitative study. Palliat Med 2018; 32:439-446. [PMID: 29130378 DOI: 10.1177/0269216317735724] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Despite being a common event in the course of an advanced cancer illness, there is little understanding of patients' perceptions of hospital Emergency Department presentations. AIM To explore the experiences and perceptions of Emergency Departments held by patients with advanced cancer and their informal caregivers. DESIGN Cross-sectional study involving semi-structured interviews with advanced cancer patients and their informal caregivers. Qualitative data analysis was underpinned by a phenomenological approach utilising a data-driven inductive thematic frame. SETTING/PARTICIPANTS In total, 19 patients with advanced cancer who presented to Emergency Departments in the previous 6 months and 10 informal caregivers from an Australian public hospital and community palliative care service were interviewed. RESULTS Patients reported that Emergency Department presentations were largely prompted by worsening symptoms or were a means to expedite hospital admission, with many instructed to attend by their health care provider. The experience in the Emergency Department was described as a time of anxiety and uncertainty with concerns over communication, the general environment and delays in the symptom management highlighted. Long waits were common. Despite this, patients described relief at receiving care. While the Emergency Department was viewed as a safety net for the health system, many believed advanced cancer patients should have alternative options. CONCLUSION Relatively simple changes of regular communication updates and early symptom relief would improve patient experience of Emergency Department care. However, since an Emergency Department presentation is frequently serving as a default to access medical care, a significant re-orientation of the health care system is required to meet patient needs.
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Affiliation(s)
- Jennifer Philip
- 1 Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia.,2 Victorian Comprehensive Cancer Centre, Parkville, VIC, Australia.,3 Palliative Medicine, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
| | | | - Sibilah Breen
- 1 Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
| | - Tracey Weiland
- 5 Neuroepidemiology Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | | | - Mark Boughey
- 3 Palliative Medicine, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
| | - George Jelinek
- 5 Neuroepidemiology Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Heather Lane
- 7 Rockingham General Hospital, Rockingham, WA, Australia
| | - Claudia Marck
- 5 Neuroepidemiology Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Jennifer Weil
- 3 Palliative Medicine, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
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22
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Langius-Eklöf A, Crafoord MT, Christiansen M, Fjell M, Sundberg K. Effects of an interactive mHealth innovation for early detection of patient-reported symptom distress with focus on participatory care: protocol for a study based on prospective, randomised, controlled trials in patients with prostate and breast cancer. BMC Cancer 2017; 17:466. [PMID: 28676102 PMCID: PMC5496395 DOI: 10.1186/s12885-017-3450-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 06/26/2017] [Indexed: 11/12/2022] Open
Abstract
Background Cancer patients are predominantly treated as out-patients and as they often experience difficult symptoms and side effects it is important to facilitate and improve patient-clinician communication to support symptom management and self-care. Although the number of projects within supportive cancer care evaluating mobile health is increasing, few evidence-based interventions are described in the literature and thus there is a need for good quality clinical studies with a randomised design and sufficient power to guide future implementations. An interactive information and communications technology platform, including a smartphone/computer tablet app for reporting symptoms during cancer treatment was created in collaboration with a company specialising in health care management. The aim of this paper is to evaluate the effects of using the platform for patients with breast cancer during neo adjuvant chemotherapy treatment and patients with locally advanced prostate cancer during curative radiotherapy treatment. The main hypothesis is that the use of the platform will improve clinical management, reduce costs, and promote safe and participatory care. Method The study is a prospective, randomised, controlled trial for each patient group and it is based on repeated measurements. Patients are consecutively included and randomised. The intervention groups report symptoms via the app daily, during treatment and up to three weeks after end of treatment, as a complement to standard care. Patients in the control groups receive standard care alone. Outcomes targeted are symptom burden, quality of life, health literacy (capacity to understand and communicate health needs and promote healthy behaviours), disease progress and health care costs. Data will be collected before and after treatment by questionnaires, registers, medical records and biomarkers. Lastly, participants will be interviewed about participatory and meaningful care. Discussion Results will generate knowledge to enhance understanding about how to develop person-centred care using mobile technology. Supporting patients’ involvement in their care to identify problems early, promotes more timely initiation of necessary treatment. This can benefit patients treated outside the hospital setting in regard to maintaining their safety. Clinical trial registration June 12 2015 NCT02477137 (Prostate cancer) and June 12 2015 NCT02479607 (Breast cancer).
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Affiliation(s)
- Ann Langius-Eklöf
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, 141 83 Huddinge, Stockholm, Sweden.
| | - Marie-Therése Crafoord
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, 141 83 Huddinge, Stockholm, Sweden
| | - Mats Christiansen
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, 141 83 Huddinge, Stockholm, Sweden
| | - Maria Fjell
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, 141 83 Huddinge, Stockholm, Sweden
| | - Kay Sundberg
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, 141 83 Huddinge, Stockholm, Sweden
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