MedicalResearch.com Interview with:
Keerat Grewal, MD, MSc, FRCPC
Schwartz/Reisman Emergency Medicine Institute
Mount Sinai Hospital
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Patients with cancer have complex care requirements and often use the emergency department. The purpose of our study was to determine whether continuity of care, cancer expertise, or both, impact outcomes among cancer patients in the emergency setting. Using administrative data we looked at adult patients with cancer who received chemotherapy or radiation therapy in the 30 days prior to an emergency department visit.
MedicalResearch.com: What should readers take away from your report?
Response: In this study, almost half of patients undergoing active treatment for cancer who seek emergency medical care for a cancer-related reason were admitted to hospital. A third of these patients were seen at an alternative emergency department from where the patient’s cancer treatment was provided.
We found that patients who were seen in an emergency department that was not associated with where they received cancer treatment were less likely to be admitted to hospital and had more repeat emergency department visits within 30 days. We then examined if patients were seen in an emergency department that was not associated with where they received cancer treatment and not one of the 14 major cancer centres in the province, and we found these patients were also less likely to be admitted to hospital and had more repeat ED visits. But they were more likely to die within 30 days of the visit.
Our results suggest that the cancer expertise of an institution is an important predictor of outcomes in the emergency care of cancer patients
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: We looked at patients with all types of cancer receiving either chemotherapy or radiation. Looking forward it would be important for studies to examine whether these results hold true across all types of cancer and both radiation and chemotherapy. Also, future research should examine whether emergency care at hospitals that are not a major cancer centre, but do provide chemotherapy have similar results.
The association of continuity of care and cancer centre affiliation with outcomes among patients with cancer who require emergency department care
Keerat Grewal, Rinku Sutradhar, Monika K. Krzyzanowska, Donald A. Redelmeier and Clare L. Atzema
CMAJ April 23, 2019 191 (16) E436-E445; DOI: https://doi.org/10.1503/cmaj.180962
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