Improving Emergency Department Care for Older Adults With Cancer

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Inpatient admission is not always the optimal treatment option.
Inpatient admission is not always the optimal treatment option.

Greater efforts and improved strategies are needed to improve medical care for older adults with cancer who present to the emergency department (ED), study findings published in the Journal of the National Comprehensive Cancer Network has shown. Researchers found that patients with cancer, especially those aged 75 years or older, are more likely to be admitted to the hospital and less likely to be observed and released home than patients without cancer.

The investigators note that inpatient admission is not always the best treatment option. Observation status is often preferable because it minimizes a patient's exposure to the inconvenience and risk of a hospital admission. In addition, a greater use of observation status can help reserve hospital resources for those who need it most.


Allison Lipitz-Snyderman, PhD, an assistant attending outcomes research scientist at Memorial Sloan Kettering Cancer Center, in New York, New York, and co-author of the study, said since not all acutely ill patients in the ED require inpatient admission for a safe discharge, observation status can provide an important alternative. “Observation status can help align patients' needs with the appropriate level and intensity of care. For cancer patients, little is known about how much observation status is used. The purpose of this study was to better understand cancer patients' use of observation status and the potential moving forward,” explained Dr Lipitz-Snyderman.

THE STUDY

This study focused on Medicare beneficiaries aged 66 years and older. Dr Lipitz-Snyderman and her team analyzed SEER-Medicare data from 151,193 patients with cancer and matched to a demographically similar control group. Those with cancer had breast, colon, lung, or prostate cancer diagnosed between 2006 and 2008.


After adjusting for patient characteristics, the researchers determined that there were only 43 observation status visits per 1000 inpatient admissions among patients with cancer. However, there were 69 observation status visits per 1000 patients in the cancer-free group. In addition, cancer-free patients with prior inpatient admission were still more likely to be placed on observation status than those with cancer but without prior hospitalizations.

Until now, there has been little known about the use of observation status for patients with cancer presenting to the ED. The investigators hope this study will draw attention to this issue and lead to changes in treatment patterns in the ED. 

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