Patients with cancer are living longer, embarking on complex treatment regimens, and experiencing more complications associated with care. As a result, a large volume of patients with cancer require urgent or emergency visits throughout their disease trajectory. Although the need remains constant, what has evolved over time are the chief complaints that bring patients in, the care associated with complications, and new options to lower the burden and cost of care.
Why Patients Need Urgent Care
Researchers investigating cancer-related visits in emergency departments identified critical gaps in understanding the clinical needs of patients with cancer in the emergency department, evidence-based emergency department interventions, and implementing efforts to reduce emergency visits among cancer patients. Understanding the most frequently cited reasons for emergency department visits and associated admissions presents a first step to addressing those gaps, and Rivera et al. found that septicemia, intestinal obstruction, congestive heart failure, and pneumonia are the most common presenting diagnoses that result in hospital admission from an emergency department. Most common cited cancer-related diagnoses in the emergency department included pneumonia, chest pain, urinary tract infections, septicemia, chronic obstructive pulmonary disease, abdominal pain and fluid and electrolyte disorders.
Many complications highly specific to oncology bring patients to emergency departments, including neutropenic fever, tumor lysis syndrome, leukostasis, and cytokine storm syndrome. As immunotherapy is increasingly used in cancer treatment plans, oncology nurses need to share the new subset of adverse events with emergency department clinicians. Immune-related adverse events are highly associated with immune checkpoint inhibitors, a growing class of agents across all disease sites.
Oncology Urgent Care Centers
Cancer centers have crafted innovative strategies to facilitate urgent care needs and support emergency clinicians in caring for patients with cancer. Some major academic medical centers have opened oncology urgent care centers, staffed by oncology nurses and oncology-trained providers, to reduce wait time, institute oncology triage algorithms, reduce hospital admissions, and prevent patients with cancer from being exposed to infectious diseases in emergency waiting rooms.
What Oncology Nurses Need to Know
Preparing patients for complications that frequently result in emergency visits is critical to preventing poor outcomes. First, provide patient education regarding the signs and symptoms associated with complications for which they are at risk based on treatment plans and disease sites, and educate them to never delay seeking medical attention should they occur. Then, prepare patients and caregivers for the situation: determine where they’ll receive the most individualized, oncology-specific care, and inform them of where to go based on time of day and urgency of symptoms. If an oncology urgent care center is within reach, determine if they’ll see patients not already affiliated with an oncologist in that practice.
Although not all cancer centers have an associate oncology emergency clinic, many are considering the practicality, cost, and feasibility. Oncology nurses are critical to these conversations and the support of patients with cancer in non-oncology care settings.