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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寻求急诊科护理的老年癌症患者特征：一项前瞻性观察研究

介绍

在癌症治疗试验和急诊科 (ED) 使用中，老年人护理存在差异。本报告提供了 65 岁以上因活动性癌症就诊于 ED 的老年人的基线描述。

材料和方法

计划对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 名符合条件的活动性癌症成人中，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 个参与站点招募了这个便利样本。

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，具有更高的 Charlson 合并症指数评分，并且尽管根据紧急严重程度衡量的敏锐度没有显着差异，但仍被收治指数。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 天内入院方面没有显着差异。在老年人的前五名 ED 诊断中，有三名与症状相关（其他和不明原因的发烧、腹部和骨盆疼痛以及喉咙和胸部疼痛）。尽管如此，与年轻的对照组相比，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。与 ED 提供者相比，年轻人和老年人都报告了患者报告的简明纪念症状评估量表的症状负担更高。在治疗疑似感染时，对于接受急诊抗生素治疗的患者，在急诊抗生素使用、入院或住院时间≤2 天方面没有差异。

讨论

我们发现了寻求急救的老年（≥65 岁）和年轻的活动性癌症患者之间的一些差异。老年人经常出现与症状相关的诊断，但在 ED 中接受的症状干预较少，这表明存在改善 ED 中患有癌症的老年人护理的重要机会。