Cancer is the second leading cause of death worldwide and has a greater impact on poor and developing nations. This is because the world’s population is getting older faster; the practice of unhealthy behaviors like smoking, living a sedentary lifestyle, and eating poorly; infections that are transmitted sexually; and a lack of access to health services that can catch problems early and treat them.
Due to their natural history, anticancer treatment, or inability to control their symptoms, oncologic patients, particularly those with advanced disease, may experience complications or a significant deterioration in their clinical condition that necessitates immediate medical attention. As a result, this action is an essential component of comprehensive care with the goals of enhancing the quality of life and relieving suffering.
This is because primary care isn’t very good and it’s hard to get high-complexity services and hospitalization. However, the logic of emergency care defies the fundamental principles of palliative care for terminally ill patients and can result in additional and unnecessary suffering.
Patients with cancer who visit the emergency department (ED) frequently have higher rates of hospital admission than patients without cancer. It has been estimated that many of these expensive hospital admissions could be avoided; however, urgent care clinics and emergency departments do not have the resources for cancer-specific care to meet the requirements of this complex population. Oncologic complication management can be improved by reducing the number of emergency room (ED) and urgent care (Urgent Care) visits. Coordinating follow-up care will be especially important as the number of cancer patients and survivors continue to rise.
In December 2021, the Office of Emergency Care (OECR) and the National Cancer Institute (NCI) organized a workshop titled “Cancer-related Emergency and Urgent Care: Prevention, Management, and Care Coordination” to draw attention to progress, knowledge gaps, and potential research areas. The current state of cancer-related urgent and emergency care is described in this report, which also includes research recommendations from workshop attendees to reduce the risk of oncologic complications, improve their management, and improve care coordination.
The NCI and OECR have worked together to support research into cancer-related emergency care since 2014. The attendees of the workshop suggested a number of promising areas for future research as well as important considerations for designing and carrying out research in this area. Unscheduled care services could be better described, people who are more likely to receive them could be identified, care delivery models could be developed to reduce unplanned events and improve care, opportunities for cancer prevention and screening could be identified in the emergency department, management of specific cancer-related presentations could be improved, and conversations about goals of care could be held.
The Comprehensive Oncologic Emergency Research Network, broad participation from the emergency medicine and oncology communities, the establishment of a proof-of-concept observational study, and NCI and OECR efforts to support this area of research have all contributed to significant progress over the past seven years. However, significant gaps persist.