Do Patient-Reported Symptoms Predict Emergency Department Visits in Cancer Patients? A Population-Based Analysis - 21/03/13
, Clare Atzema, MD c, g, Rinku Sutradhar, PhD e, g, Hsien Seow, PhD g, h, i, Doris Howell, PhD d, Amna Husain, MD f, Jonathan Sussman, MD h, i, Craig Earle, MD c, g, Ying Liu, MSc g, Deborah Dudgeon, MD j
Address for correspondence: Lisa Barbera, MDRésumé |
Study objective |
Since 2007 in Ontario, Canada, the Edmonton Symptom Assessment System has been routinely used for cancer outpatients. The purpose of this study is to determine the relationship between individual patient symptoms and symptom severity, with the likelihood of an emergency department (ED) visit.
Methods |
The cohort included all cancer patients in Ontario who completed an Edmonton Symptom Assessment System between January 2007 and March 2009. Using multiple linked provincial health databases, we examined the adjusted association between symptom scores and the likelihood of an ED visit within 7 days of assessment.
Results |
The cohort included 45,118 patients whose first assessment contributed to the study, of whom 3.8% made a subsequent ED visit. A severe well-being score was associated with the highest odds of a subsequent ED visit (adjusted odds ratio [OR] 1.9; 95% confidence interval 1.5 to 2.4). Nausea, drowsiness, and shortness of breath with moderate or severe scores were associated with ED visits (adjusted OR 1.2 to 1.5), whereas pain, tiredness, poor appetite, and well-being had a significant association for mild scores (adjusted OR 1.2, 1.3, 1.2, and 1.3, respectively), moderate scores (adjusted OR 1.3, 1.5, 1.5, and 1.7, respectively), and severe scores (adjusted OR 1.4, 1.7, 1.7, and 1.9, respectively). Anxiety and depression were not associated with ED visits.
Conclusion |
Worsening symptoms contribute to emergency visits in cancer patients. Specific symptoms such as pain are obvious management targets, but constitutional symptoms were associated with even higher odds of ED usage and therefore warrant detailed assessment to optimize both patient outcomes and resource use.
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| Supervising editor: Donald M. Yealy, MD |
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| Author contributions: LB, CA, HS, DH, AH, JS, CE, and DD conceived the study, obtained research funding, and interpreted the results. LB, CA, HS, DH, AH, and DD were responsible for study design. LB and RS were responsible for supervision of the analysis. YL was responsible for performing the analysis. RS was responsible for statistical advice. LB was responsible for drafting the article, and all authors approved the final article. LB takes responsibility for the paper as a whole. |
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| Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). The authors have stated that no such relationships exist. This study was conducted with the support of the Ontario Institute for Cancer Research through funding provided by the Government of Ontario. This study was supported by the Institute for Clinical Evaluative Sciences (ICES), which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC). The opinions, results, and conclusions reported in this article are those of the authors and are independent from the funding sources. No endorsement by ICES or the Ontario MOHLTC is intended or should be inferred. |
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| Publication date: Available online January 4, 2013. |
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| Please see page 428 for the Editor's Capsule Summary of this article. |
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Vol 61 - N° 4
P. 427 - avril 2013 Retour au numéro
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