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World J Clin Oncol. Apr 10, 2016; 7(2): 227-233
Published online Apr 10, 2016. doi: 10.5306/wjco.v7.i2.227
Integrating palliative care in oncologic emergency departments: Challenges and opportunities
Ahmed F Elsayem, Hiba E Elzubeir, Patricia A Brock, Knox H Todd
Ahmed F Elsayem, Hiba E Elzubeir, Patricia A Brock, Knox H Todd, Department of Emergency Medicine, University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
Author contributions: All authors contributed to this paper.
Conflict-of-interest statement: All authors have no conflict of interest to report.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Ahmed F Elsayem, MD, Department of Emergency Medicine, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1468, Houston, TX 77030, United States. aelsayem@mdanderson.org
Telephone: +1-713-7922582 Fax: +1-713-7928743
Received: August 21, 2015
Peer-review started: August 24, 2015
First decision: October 13, 2015
Revised: December 1, 2015
Accepted: December 18, 2015
Article in press: December 21, 2015
Published online: April 10, 2016
Processing time: 229 Days and 21.2 Hours
Abstract

Although visiting the emergency departments (EDs) is considered poor quality of cancer care, there are indications these visits are increasing. Similarly, there is growing interest in providing palliative care (PC) to cancer patients in EDs. However, this integration is not without major challenges. In this article, we review the literature on why cancer patients visit EDs, the rates of hospitalization and mortality for these patients, and the models for integrating PC in EDs. We discuss opportunities such integration will bring to the quality of cancer care, and resource utilization of resources. We also discuss barriers faced by this integration. We found that the most common reasons for ED visits by cancer patients are pain, fever, shortness of breath, and gastrointestinal symptoms. The majority of the patients are admitted to hospitals, about 13% of the admitted patients die during hospitalization, and some patients die in ED. Patients who receive PC at an ED have shorter hospitalization and lower resource utilization. Models based solely on increasing PC provision in EDs by PC specialists have had modest success, while very limited ED-based PC provision has had slightly higher impact. However, details of these programs are lacking, and coordination between ED based PC and hospital-wide PC is not clear. In some studies, the objectives were to improve care in the communities and reduce ED visits and hospitalizations. We conclude that as more patients receive cancer therapy late in their disease trajectory, more cancer patients will visit EDs. Integration of PC with emergency medicine will require active participation of ED physicians in providing PC to cancer patients. PC specialist should play an active role in educating ED physicians about PC, and provide timely consultations. The impact of integrating PC in EDs on quality and cost of cancer care should be studied.

Keywords: Emergency department; Cancer; Palliative care; Integration; Quality; Cost

Core tip: Understandably, visiting the emergency department (ED) could be a difficult experience for the many cancer patients especially in the late stages. However, these visits are increasing, and it mirrors the increased in cancer therapies particularly in the last two decades. In this article; we discuss why cancer patients visit EDs, the outcome of these visits, models to help cancer patients avoid ED visits, the benefits of integrating palliative care in ED, and the challenges facing such integration.