A study evaluated the impact of oncology nurse navigators (ONNs) on emergency department (ED) visits and hospital admissions among adult patients with cancer post-outpatient chemotherapy. The results demonstrated that these outcomes were not appropriate metrics for considering the efficacy of ONNs. These study results were reported in the journal Oncology Nursing Forum.

“A variety of complex factors were associated with ED visits and hospital admissions for this population, with some opportunities for prevention likely outside of the ONN’s control,” the study investigators wrote in their report.

Prior studies have identified benefits of ONNs in cancer care, explained the investigators. However, it had been unclear whether there is an effect of ONNs on ED visits and hospital admissions post-outpatient chemotherapy.

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In this retrospective, cross-sectional study, the researchers analyzed data from electronic health records for patients with cancer who had received outpatient chemotherapy at a community cancer center within an integrated health care system in southern California. The numbers of ED visits and hospital admissions, both in combination and individually, were outcomes of interest, in addition to length of stay (LOS) for ED visits and hospital admissions.

The investigators evaluated 1370 patients, mean age 62.55 years (SD, 13.35). The most common cancer diagnoses were breast cancer (26%), lymphoma (12%), and lung cancer (11%). Insurance status was private insurance for 50% of the study population and Medicare coverage for 46%.

Over the course of 2 years, 12,317 visits were for chemotherapy infusions among patients in the study, with 230 ED visits and 449 hospital admissions during this time. Approximately 35% of patients had an ED visit or hospital admission during the 2-year period. ED visits alone were reported for 9%, hospital admissions alone were reported for 21%, and the remaining 5% had both ED visits and hospital admissions.

Most patients (63%) received 1 or more ONN assessments. Multiple factors were significantly associated with having ONN involvement; however, no significant relationships were shown with the number of ED visits, the number of hospital admissions, the average LOS for ED visits, or the average LOS for hospitalizations.

Based on multiple linear regression analyses, the researchers identified several factors that appeared to be predictors of the number of ED visits. These included age, gender, Medicare insurance status, chemotherapy location, and 10 chemotherapy-related conditions. Predictors of the number of hospital admissions appeared to be age, gender, and 9 chemotherapy-related conditions.

The study investigators concluded that ONN involvement was not a contributor to predictive models of ED visits or hospital admissions. “This result does not preclude the benefit of ONNs,” the investigators wrote. “Instead, it emphasizes the ONN scope of responsibilities and related outcome measures,” they continued. They also indicated in their report that other process measures should be evaluated in measurement of ONN efficacy.


Stirling SL, Etland C, Connelly CD, Calero P, Ecoff L. Oncology nurse navigator effect on emergency department visits and hospital admissions of adults with cancer post–outpatient chemotherapy. Oncol Nurs Forum. 2022;49(6):595-612. doi:10.1188/22.ONF.595-612