Emergency Department Use and Unplanned Hospitalization Among Patients With Head and Neck Cancer: Association With Reported Symptom Burden

Get Permission

In a Canadian population-based study reported in the Journal of Clinical Oncology, Noel et al found that patient-reported symptom burden was significantly associated with the likelihood of emergency department use and unplanned hospitalization among patients with head and neck cancer.

Study Details

The study involved data from 11,761 patients who completed at least one outpatient Edmonton Symptom Assessment System (ESAS) assessment between January 2007 and March 2018 in Ontario. Logistic regression analysis was used to assess the relationship between outpatient ESAS scores and subsequent 14-day emergency department/hospital use.

Key Findings

The 11,761 patients completed a total of 73,282 ESAS assessments and experienced 5,203 emergency department/hospital events.

On multivariate analysis, six of the nine ESAS symptom scores were positively associated with emergency department hospital use; odds ratios per one-unit increase were:

  • 1.09 (P < .01) for pain
  • 1.06 (P < .01) for lack of appetite
  • 1.05 (P < .01) for shortness of breath
  • 1.05 (P < .01) for tiredness
  • 1.04 (P < .01) for drowsiness
  • 1.04 (P < .01) for well-being.

Global ESAS scoring (calculated by selecting the highest individual symptom score [h-ESAS score]), showed that 40.3%, 27.2%, and 32.6% of patients had h-ESAS scores of 0–3 (none or mild), 4–6 (moderate), and 7–10 (severe), respectively. Emergency department/hospital events within 14 days were experienced by 15.1% of patients with a score of 10 vs 1.5% of patients with a score of 0. Percentages of patients with emergency department/hospital events for scores 1–9 were 2.3%, 2.4%, 3.8%, 4.6%, 5.3%, 7.2%, 7.7%, 10.0%, and 12.9%, respectively.  

On adjusted analysis, the odds ratio for emergency department/hospital use with each one-unit increase in h-ESAS as a continuous variable was 1.23 (95% confidence interval [CI] =1.22–1.25). When h-ESAS was analyzed as a categoric variable, the odds ratio for emergency department/hospital use was 9.23 (95% CI = 7.22–11.33) for patients with a score of 10 vs those with a score of 0.

The investigators concluded, “ESAS scores are strongly associated with subsequent emergency department/hospital events in patients with head and neck cancer. Clinician education around how ESAS data might inform patient care may enhance symptom detection and management.”

Antoine Eskander, MD, ScM, of Sunnybrook Health Sciences Centre, Toronto, is the corresponding author for the Journal of Clinical Oncology article. 

Disclosure: The study was supported by the Canadian Institute of Health Research, Academic Health Science Centre Alternative Funding Plan Innovation Fund at Sunnybrook Health Sciences Centre, Ontario Ministry of Health and Long-Term Care, and others. For full disclosures of the study authors, visit

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.