Understanding Mortality and Morbidity Rates among Cancer patients from the Emergency Department

ABSTRACT

Introduction: Despite significant improvements in early detection and treatment, the disparities seen among cancer patients have persisted. Sepsis and Deep Vein Thrombosis (DVT) / Pulmonary Embolus (PE) remain leading causes of death among cancer patients. Emergency departments (ED) serve as critical entry points into the inpatient acute care setting. The novel SARS-COV2 virus has intensified the risk facing these patients. The purpose of this study is to characterize the mortality and morbidity rates in cancer patients admitted through the ED of an urban academic hospital. Methods: Retrospective cohort analysis of cancer patients seen in the ED in 2019. Billing data was used to identify the cohort of cancer patients using the terms “Neoplasm”, “Malignant”, “Malignancy” or “Cancer”. Excluded were terms like benign, family history or screening. The final cohort included patients with both active cancer as well as those with a history of cancer. Results: Of the 27,327 unique patients seen in the ED, 1,597 (5.8%) were cancer patients, accounting for 3,135 (6.9%) visits. Of the total of 133 deaths seen in patients admitted through the ED, 29 (21.8%) were in cancer patients. This represents a mortality rate of 9.3 per 1000 visits (18.2 per 1000 patients). This is in contrast to an overall mortality rate of 2.9 per 1000 visits (4.9 per 1000 patients). Among the cancer cohort, the mortality rate increased to 20% (7/35) with a sepsis diagnosis and 4.8% (2/41) with a diagnosis of DVT/PE. Conclusion: Understanding the significant risk associated with cancer patients requiring inpatient admission highlights the needs for screening protocols for early detection of life-threatening conditions such as sepsis and DVT/PE upon entry into the inpatient setting, especially among populations at risk for poor outcomes.