Presentation patterns and outcomes of patients with cancer accessing care in emergency departments in Victoria, Australia.

PURPOSE: People with cancer attend emergency departments (EDs) for many reasons. Improved understanding of the specific needs of these patients may assist in optimizing health service delivery. ED presentation and hospital utilization characteristics were explored for people with cancer and compared with those patients without cancer. METHODS: This descriptive, retrospective, multicentre cohort study used hospital administrative data. Descriptive and inferential statistics were used to summarise and compare ED presentation characteristics amongst cancer and non-cancer groups. Predictive analyses were used to identify ED presentation features predictive of hospital admission for cancer patients. Outcomes of interest were level of acuity, ED and inpatient length of stay, re-presentation rates and admission rates amongst cancer patients and non-cancer patients. RESULTS: ED (529,377) presentations occurred over the 36 months, of which 2.4% (n = 12,489) were cancer-related. Compared with all other attendances, cancer-related attendances had a higher level of acuity, requiring longer management time and length of stay in ED. Re-presentation rates for people with cancer were nearly double those of others (64 vs 33%, p < 0.001), with twice the rate of hospital admission (90 vs 46%, p < 0.001), longer inpatient length of stay (5.6 vs 2.8 days, p < 0.001) and had higher inpatient mortality (7.9 vs 1.0%, p < 0.001). Acuity and arriving by ambulance were significant predictors of hospital admission, with cancer-related attendances having ten times the odds of admission compared to other attendances (OR = 10.4, 95% CI 9.8-11.1). CONCLUSIONS: ED presentations by people with cancer represent a more urgent, complex caseload frequently requiring hospital admission when compared to other presentations, suggesting that for optimal cancer care, close collaboration and integration of oncology, palliative care and emergency medicine providers are needed to improve pathways of care.

'Pretty fit and healthy': The discussion of older people in cancer multidisciplinary meetings.

INTRODUCTION: Cancer multidisciplinary meetings (MDMs) are central to treatment decision making. The language used in MDMs may influence treatment decisions, yet has received little research attention. This study aimed to examine the terminology used to describe non-cancer items in the discussion of older people within cancer MDMs. METHODS: MDMs of four tumour streams were attended over twelve weeks. For each person aged 70 or older discussed, the following was hand recorded: age, gender, and phrases describing non-cancer items and patient views. A qualitative thematic analysis was employed to examine the text. RESULTS: Twenty cancer MDMs were attended, at which 71 people aged 70 or older were discussed. Age, comorbid medical conditions, and general descriptors emerged as the areas in which non-cancer information was presented. In contrast to the medical terminology used to describe comorbid medical conditions, non-specific general descriptors, such as 'fit', 'well', and 'good', were used to describe other aspects of older people. Adverbs, including 'very', 'pretty', and 'quite', often accompanied general descriptors. The, often subtle, intonation and context associated with these adverbs resulted in markedly different meanings. CONCLUSION: Non-objective, potentially ambiguous general descriptors were commonly used to encompass non-disease aspects of older people in cancer MDMs. These descriptors may have the potential to sway treatment recommendations. However, their frequent use suggests team members recognise that non-disease aspects of a person, aside from chronological age, are considerations in treatment recommendations. Therefore, strategies to increase discussion of non-cancer items in a more objective manner may be acceptable to MDM attendees.