title: Are Patients With Thoracic Malignancies at Risk for Uncontrolled Symptoms?
abstract: Patients with cancer often develop symptoms and contact their oncologists and care teams after normal clinic operating hours. Better understanding of these after-hours telephone calls can inform efforts to improve cancer care and to reduce health care spending. We sought to evaluate after-hours calls at Stanford Cancer Institute (SCI) Thoracic Oncology Clinic.
  
  
  
  We retrospectively analyzed content of telephone call notes made to SCI during weekends and from 5 pm to 8 am on weekdays. Chief complaint, caller and patient demographics, patient diagnosis, advice given, and disposition were analyzed. χ(2) tests were used to analyze differences in proportions.
  
  
  
  There were a total of 263 after-hours telephone calls during the 6 months of the study. After exclusions, there were 241 telephone calls for analysis. The majority of calls occurred between 5 pm to 11 pm (n = 175 [73%]; P < .001), followed by daytime calls on weekends (n = 157 [65%]; P < .001). Common symptoms were cough (28%) and dyspnea (27%). Of the calls, 62% (150 patients) resulted in emergency department (ED) referral, and 77% of patients (115 of 150) evaluated in the ED were admitted to the hospital.
  
  
  
  Most after-hours telephone calls from patients with lung cancer are related to symptoms. Many patients were referred to the ED and subsequently required hospitalization. Analysis of call content and prior events leading to after-hours calls may predict hospital admissions in this group of patients and can inform development of proactive interventions to improve quality of care and patient-centered outcomes.
authors.affiliation: Stanford University; Stanford Hospitals and Clinics, Stanford; and University of California Los Angeles, Los Angeles, CA manalip@stanford.edu.
authors.forename: Manali I
authors.initials: MI
authors.lastname: Patel
authors.affiliation: Stanford University; Stanford Hospitals and Clinics, Stanford; and University of California Los Angeles, Los Angeles, CA.
authors.forename: Donna C
authors.initials: DC
authors.lastname: Williams
authors.affiliation: Stanford University; Stanford Hospitals and Clinics, Stanford; and University of California Los Angeles, Los Angeles, CA.
authors.forename: Carla
authors.initials: C
authors.lastname: Wohlforth
authors.affiliation: Stanford University; Stanford Hospitals and Clinics, Stanford; and University of California Los Angeles, Los Angeles, CA.
authors.forename: George
authors.initials: G
authors.lastname: Fisher
authors.affiliation: Stanford University; Stanford Hospitals and Clinics, Stanford; and University of California Los Angeles, Los Angeles, CA.
authors.forename: Heather A
authors.initials: HA
authors.lastname: Wakelee
authors.affiliation: Stanford University; Stanford Hospitals and Clinics, Stanford; and University of California Los Angeles, Los Angeles, CA.
authors.forename: Douglas W
authors.initials: DW
authors.lastname: Blayney
mesh_terms: D000328:Adult; D039602:After-Hours Care / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D002140:California; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D005334:Fever / Q000209:etiology; D006760:Hospitalization / Q000706:statistics & numerical data; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D008175:Lung Neoplasms / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013689:Telephone / Q000706:statistics & numerical data*; D014218:Triage; D014839:Vomiting / Q000209:etiology