Non-scheduled consultation in oncologic patients. How many of them are true emergencies? An observational prospective study.
Oncologic emergencies have been extensively described and clearly defined. In oncology daily practice, cancer patients seek non-scheduled medical care in situations they perceive as a medical emergency, but which may not be a true emergency. The aim of the study was to identify the main symptoms leading to a non-scheduled consultation (NSC) and their relationship to the type of cancer, and to evaluate whether the diagnosis at discharge of patients admitted as result of a NSC correlates with a true oncologic emergency. This was a prospective observational study. Between July 2002 and April 2003, 365 NSCs were recorded. The most frequent baseline diseases were breast cancer (70), lung cancer (67), gastrointestinal cancer (52), lymphoma (42) and ovarian cancer (22). The most common symptoms for consultation were: fever (84), pain (81), cutaneous manifestations (26), dyspnea (23), bleeding (16) and abdominal distention (16). Overall, 114 of 365 NSCs (31%) resulted in admission. The most frequent symptoms resulting in admission were fever (42), pain (16), dyspnea (11), vomiting (9), neurologic manifestations (7), abdominal distention (6) and anuria (6). At discharge, only 30 patients (26%) admitted after a NSC were diagnosed with a defined oncologic emergency: febrile neutropenia (13), intestinal occlusion (12), obstructive uropathy (4) and abdominal perforation (1). True emergencies were not the most frequent causes of NSC at our institution.
Díaz-Couselo
F A
FA
Department of Internal Medicine, Instituto Alexander Fleming, Crámer 1180, Ciudad de Buenos Aires, Argentina.
O'Connor
J M
JM
Nervo
A
A
Tossen
G
G
Guercovich
A
A
Puparelli
C
C
Coronado
C
C
Costanzo
V
V
Zylberman
M
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001118:Argentina; D001943:Breast Neoplasms / Q000150:complications; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000150:complications; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology; D007416:Intestinal Perforation / Q000209:etiology; D008175:Lung Neoplasms / Q000150:complications; D008223:Lymphoma / Q000150:complications; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D009503:Neutropenia / Q000209:etiology; D016522:Oncology Service, Hospital / Q000706:statistics & numerical data*; D010051:Ovarian Neoplasms / Q000150:complications; D010343:Patient Admission / Q000706:statistics & numerical data; D010351:Patient Discharge / Q000706:statistics & numerical data; D011446:Prospective Studies; D014570:Urologic Diseases / Q000209:etiology