Progressive disease in patients with cancer presenting to an emergency room with acute symptoms predicts short-term mortality.
OBJECTIVE
Patients with symptomatic, advanced cancer continue to be referred late or not at all for hospice or palliative care. We conducted a retrospective cohort study to determine whether evidence of cancer progression is an independent predictor of short-term mortality in acutely symptomatic cancer patients.


METHODS
We reviewed the records of 396 patients who visited the emergency center at a comprehensive cancer center in January 2000. Records were reviewed for clinical characteristics, including symptoms, type and extent of cancer, and whether the patient's cancer was stable or progressing (uncontrolled) at the time of the emergency center visit. Cox regression analysis was used to assess survival at 90 and 180 days, after controlling for patient characteristics.


RESULTS
Patients who died within 14, 90, or 180 days were more likely to have disease progression than those who did not. Dyspnea on emergency center presentation and disease progression were independent predictors of death within 90 or 180 days, after controlling for patient age, symptoms, signs, and the presence of metastases. The odds ratios for death within 90 and 180 days were 3.97 and 4.34, respectively (95% confidence intervals: 1.44, 10.94 and 1.87, 10.09).


CONCLUSIONS
Cancer disease progression is a clinical measure of increased risk of short-term mortality in acutely symptomatic cancer patients. Future studies should examine whether the use of this characteristic enhances identification of patients who could benefit from timely referral to hospice or palliative care. Symptomatic cancer patients presenting to a cancer center emergency room were more likely to die within 14, 90, or 180 days if they had evidence of recent progression of their cancer. Among patients with disease progression, 47% died within 90 days and 61% within 180 days.
Department of General Internal Medicine, Ambulatory Treatment and Emergency Care, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 437, Houston, TX 77030, USA. jmgeraci@mdanderson.org
Jane M
JM
Geraci
Walter
W
Tsang
Rosalie V
RV
Valdres
Carmen P
CP
Escalante
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003248:Constipation / Q000209:etiology; D018450:Disease Progression; D004417:Dyspnea / Q000209:etiology; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005221:Fatigue / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009325:Nausea / Q000209:etiology; D009369:Neoplasms / Q000150:complications / Q000401:mortality*; D010146:Pain / Q000209:etiology; D010343:Patient Admission; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D015996:Survival Rate; D013781:Texas / Q000453:epidemiology; D013997:Time Factors; D014839:Vomiting / Q000209:etiology