Oncology-related concerns in ED may be managed in outpatient setting, says study

Some cancer patients with acute oncology-related presentations at the emergency department (ED) can be managed at ambulatory clinics, suggests a Singapore study.

“Consideration should be given to managing potentially dischargeable cancer patients at outpatient primary care settings,” said the researchers, who performed a retrospective audit of individuals with cancer-related diagnoses presenting to the ED at the Singapore General Hospital (SGH) over 6 months from 1 October 2018 to 31 March 2019.

These oncology patients were directly discharged from the ED. The electronic medical record system of the SGH was used to extract data from 492 participants.

Of the patients, 61.4 percent were triaged as priority 2, 30.7 percent as priority 3, 6.9 percent as priority 1, and 1.0 percent as priority 4. No statistical difference was observed between the National Early Warning scores across various triage categories among participants. [Singapore J Med 2025;66:97-101]

Pain was the most common complaint (44.3 percent), followed by genitourinary symptoms (19.5 percent) and those related to devices, catheters, or stomas (17.3 percent).

Among the 218 patients with complaints of pain, 79 had metastatic disease. Furthermore, 43.6 percent had mild pain, while 34.9 percent and 21.5 percent had moderate and severe pain, respectively. The majority (89.5 percent) of those with mild severity did not require any analgesia in the ED.

Patients who were triaged as priority 1 (57.6 percent) underwent more investigations of all types than those in other triage categories: 40.1 percent for priority 2, 23.2 percent for priority 3, 12.0 percent for priority 4. Treatment procedures done were primarily symptomatic for 79.8 percent of the patients, which included analgesics, antiemetics, and proton pump inhibitors.

“There were no significant differences in the proportion of patients requiring various treatment modalities among the triage categories,” the researchers said.

High admission rates

In the current study, only 9.2 percent of patients with active cancers were discharged from the ED, and the rest were admitted as inpatients. The high admission rates indicated the low threshold to manage patients with all forms of cancer as inpatients, particularly those with terminal disease. [JAMA Netw Open 2019;2:e190979; Indian J Palliat Care 2018;24:25-27]

Such cases may serve as an opportunity for reviewing admissions which could be managed on an ambulatory basis, according to the researchers.

“Over-admission of cancer patients to the hospital poses its own set of risks, such as hospital-acquired infection, deep venous thrombosis, disorientation and falls, which may outweigh the benefits of inpatient care,” they said. [JAMA Netw Open 2019;2:e190979]

Simple haematological and biochemical tests are readily available in the outpatient setting. However, “advice and education on whether to present to the ED or what steps to take in the event of medical complaints are best provided by … oncologists, as they are more familiar with the patients and their cancer journey,” the researchers said.

In addition, another area that warrants consideration for improvement of outpatient oncology care is the high proportion of patients with prostate cancers presenting with acute urinary retention and other urinary symptoms. Doing so can help reduce overcrowding at the EDs, according to the researchers.