Introduction

Disparities in care of older adults in cancer treatment trials and emergency department (ED) use exist. This report provides a baseline description of older adults ≥65 years old who present to the ED with active cancer.

Materials and methods

Planned secondary analysis of the Comprehensive Oncologic Emergencies Research Network observational ED cohort study sponsored by the National Cancer Institute. Of 1564 eligible adults with active cancer, 1075 patients were prospectively enrolled, of which 505 were ≥ 65 years old. We recruited this convenience sample from eighteen participating sites across the United States between February 1, 2016 and January 30, 2017.

Results

Compared to cancer patients younger than 65 years of age, older adults were more likely to be transported to the ED by emergency medical services, have a higher Charlson Comorbidity Index score, and be admitted despite no significant difference in acuity as measured by the Emergency Severity Index. Despite the higher admission rate, no significant difference was noted in hospitalization length of stay, 30-day mortality, ED revisit or hospital admission within 30 days after the index visit. Three of the top five ED diagnoses for older adults were symptom-related (fever of other and unknown origin, abdominal and pelvic pain, and pain in throat and chest). Despite this, older adults were less likely to report symptoms and less likely to receive symptomatic treatment for pain and nausea than the younger comparison group. Both younger and older adults reported a higher symptom burden on the patient reported Condensed Memorial Symptom Assessment Scale than to ED providers. When treating suspected infection, no differences were noted in regard to administration of antibiotics in the ED, admissions, or length of stay ≤2 days for those receiving ED antibiotics.

Discussion

We identified several differences between older (≥65 years old) and younger adults with active cancer seeking emergency care. Older adults frequently presented for symptom-related diagnoses but received fewer symptomatic interventions in the ED suggesting that important opportunities to improve the care of older adults with cancer in the ED exist.

中文翻译：

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寻求紧急急诊科护理的老年癌症患者的特征：一项前瞻性观察研究

 介绍

在癌症治疗试验和急诊科 (ED) 使用方面，老年人的护理存在差异。本报告提供了到急诊科就诊的患有活动性癌症的≥65 岁老年人的基线描述。

 材料和方法

计划对美国国家癌症研究所赞助的综合肿瘤紧急情况研究网络观察性 ED 队列研究进行二次分析。在 1564 名符合资格的活动性癌症成年人中，前瞻性纳入了 1075 名患者，其中 505 名年龄≥ 65 岁。我们在 2016 年 2 月 1 日至 2017 年 1 月 30 日期间从美国 18 个参与站点收集了这个便利样本。

 结果

与 65 岁以下的癌症患者相比，老年人更有可能被紧急医疗服务送往急诊室，查尔森合并症指数评分更高，并且尽管根据紧急严重程度衡量的严重程度没有显着差异，但仍被入院治疗指数。尽管入院率较高，但住院时间、30 天死亡率、急诊复诊或初次就诊后 30 天内入院情况没有显着差异。老年人前五名急诊诊断中的三名与症状相关（其他和不明原因的发烧、腹部和盆腔疼痛以及喉咙和胸部疼痛）。尽管如此，与年轻对照组相比，老年人报告症状的可能性较小，接受疼痛和恶心对症治疗的可能性也较小。年轻人和老年人都报告说，患者报告的简明纪念症状评估量表的症状负担比急诊提供者的症状负担更高。在治疗疑似感染时，在急诊科使用抗生素、入院或接受急诊科抗生素治疗的住院时间≤2天方面没有发现差异。

 讨论

我们发现患有活动性癌症且寻求紧急护理的老年人（≥65 岁）和年轻人之间存在一些差异。老年人经常就诊进行与症状相关的诊断，但在急诊室接受的症状干预较少，这表明改善急诊室对患有癌症的老年人的护理存在重要机会。