SEATTLE - May 30, 2017 - As many as 53 percent of cancer patients' Emergency Department visits that do not require admission could be avoided with better symptom management and greater availability of outpatient care tailored to their needs, according to a new study from Fred Hutchinson Cancer Research Center.

Although a number of studies have addressed the prevalence of ED visits among cancer patients, this is the first to systematically identify potentially preventable ED visits during treatment. Dr. Laura Panattoni, a staff scientist at the Hutchinson Institute for Cancer Outcomes Research, or HICOR, and colleagues followed cancer patients in 13 Western Washington counties with solid tumors whose treatment included chemotherapy, radiation or both.

"My hope is that seeing this data will promote innovative thinking and investment in how oncology teams manage patient symptoms," Panattoni said. "Managing nausea, pain, dehydration, diarrhea and other symptoms in an outpatient setting has great potential to improve patient experience and decrease the cost of care."
Panattoni is scheduled to present these findings at the 2017 American Society of Clinical Oncology Annual Meeting in Chicago on June 5 at 9:24 a.m. (ASCO abstract number 6505.)

Measuring what matters

The study began with data from 5,853 commercially insured patients who were 18 years or older, diagnosed with a solid tumor and treated with chemotherapy, radiation or both. Out of that population, 27 percent, or 1,581 patients, visited the ED without being admitted in the year after starting treatment.

Panattoni and her colleagues tallied 2,400 ED visits by these 1,581 cancer patients and then set about analyzing whether they could have been prevented.

Using a list of symptoms that federal health authorities identified as preventable, combined with symptoms targeted by patient-reported outcome tools, the researchers found that slightly more than half of these ED visits -- 53 percent -- were related to symptoms that could be managed with timely care in an outpatient setting.

The share of potentially preventable visits rose to 70 percent when Panattoni expanded the standard to include other common patient complaints, as well as symptoms associated with chronic health conditions.

"At a time when federal authorities and private payers are linking insurance payments to hospital quality measures, this study points to the importance of developing methods to accurately identify those ED visits that are preventable versus those that are appropriate," Panattoni commented.

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