Palliative Care Needs and Clinical Outcomes of Patients with Advanced Cancer in the Emergency Department.

Abstract

<b><i>Background:</i></b> Older adults with cancer use the emergency department (ED) for acute concerns. <b><i>Objectives:</i></b> Characterize the palliative care needs and clinical outcomes of advanced cancer patients in the ED. <b><i>Design:</i></b> A planned secondary data analysis of the Comprehensive Oncologic Emergencies Research Network (CONCERN) data. <b><i>Settings/Subjects:</i></b> Cancer patients who presented to the 18 CONCERN affiliated EDs in the United States. <b><i>Measurements:</i></b> Survey included demographics, cancer type, functional status, symptom burden, palliative and hospice care enrollment, and advance directive code status. <b><i>Results:</i></b> Of the total (674/1075, 62.3%) patients had advanced cancer and most were White (78.6%) and female (50.3%); median age was 64 (interquartile range 54-71) years. A small proportion of them were receiving palliative (6.5% [95% confidence interval; CI 3.0-7.6]; <i>p</i> = 0.005) and hospice (1.3% [95% CI 1.0-3.2]; <i>p</i> = 0.52) care and had a higher 30-day mortality rate (8.3%, [95% CI 6.2-10.4]). <b><i>Conclusions:</i></b> Patients with advanced cancer continue to present to the ED despite recommendations for early delivery of palliative care.