In a retrospective cohort study reported in JCO Oncology Practice, Hong et al found that prior frequent emergency department use was the strongest predictor of postdiagnosis emergency department visits among patients with a new diagnosis of cancer.
Study Details
The study involved data from adults with an incident cancer diagnosis (excluding nonmelanoma skin cancers and leukemia) at the University of Texas Southwestern Medical Center in Dallas between 2008 and 2018, and the Parkland Health & Hospital System safety-net hospital in Dallas between 2012 and 2016. The primary outcome measure was the number of emergency department visits in the first 6 months after cancer diagnosis, assessed using a multivariable regression analysis accounting for emergency department visit history in the 6 to 12 months preceding cancer diagnosis, electronic health record proxy social determinants of health, and clinical cancer-related characteristics.
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Key Findings
Among the 35,090 patients with cancer included in the analysis, 38% were aged ≥ 65 years; 49% were female; 50% were non-Hispanic White, 21% were Hispanic, and 23% were Black; 17% were uninsured (county charity assistance); 24% had advanced-stage disease at diagnosis; 5% died within 180 days of diagnosis; and 0.8% were homeless.
Overall, 57.2% of patients had one or more emergency department visit(s) in the 6 months after diagnosis (48.1% with 1 to 3 visits; 9.1% with ≥ 4 visits). During the 6 to 12 months prior to diagnosis, 19.5% had one or more emergency department visits (18.2% with 1 to 3 visits; 1.4% with ≥ 4 visits).
On multivariate analysis, the strongest predictor of postdiagnosis emergency department visits was four or more prediagnosis emergency department visits (adjusted incidence rate ratio [IRR] = 3.68, 95% confidence interval [CI] = 3.36–4.02). Having one to three prediagnosis emergency department visits was also associated with greater likelihood of postdiagnosis emergency department visits (adjusted IRR = 1.32, 95% CI = 1.28–1.36).
Social determinants of health variables associated with greater likelihood of postdiagnosis visits were Hispanic (adjusted IRR = 1.12, 95% CI = 1.07–1.17) and Black (adjusted IRR = 1.21, 95% CI = 1.17–1.25) race/ethnicity, Medicaid insurance (adjusted IRR = 1.45, 95% CI = 1.39–1.52) and county charity assistance (adjusted IRR = 1.32, 95% CI = 1.27–1.38), and homelessness (adjusted IRR = 1.95, 95% CI = 1.73–2.20).
Clinical variables associated with greater likelihood of postdiagnosis visits were advanced-stage cancer at diagnosis (adjusted IRR = 1.30, 95% CI = 1.26–1.35), initial treatment that included chemotherapy (adjusted IRR = 1.44, 95% CI = 1.40–1.48), and lung (adjusted IRR = 1.26, 95% CI = 1.19–1.34) and colorectal cancers (adjusted IRR = 1.19, 95% CI = 1.11–1.28). Breast cancer was associated with fewer postdiagnosis emergency department visits (adjusted IRR = 0.91, 95% CI = 0.86–0.97).
The investigators concluded, “The strongest independent predictor for emergency department use after a new cancer diagnosis was frequent emergency department visits before cancer diagnosis. Efforts to reduce potentially avoidable emergency department visits among patients with cancer should consider educational initiatives that target heavy prior emergency department users and offer them alternative ways to seek urgent medical care.”
Arthur S. Hong, MD, MPH, of the University of Texas Southwestern Medical Center, Dallas, is the corresponding author for the JCO Oncology Practice article.
Disclosure: The study was supported by the Texas Health Resources Clinical Scholars Program, National Center for Advancing Translational Sciences of the National Institutes of Health, Agency for Healthcare Research and Quality, National Cancer Institute, and American Cancer Society. For full disclosures of the study authors, visit ascopubs.org.
