title: Presentation patterns and outcomes of patients with cancer accessing care in emergency departments in Victoria, Australia.
abstract: OBJECTIVE
  People with cancer attend emergency departments (EDs) for many reasons. Improved understanding of the specific needs of these patients may assist in optimizing health service delivery. ED presentation and hospital utilization characteristics were explored for people with cancer and compared with those patients without cancer.
  
  
  METHODS
  This descriptive, retrospective, multicentre cohort study used hospital administrative data. Descriptive and inferential statistics were used to summarise and compare ED presentation characteristics amongst cancer and non-cancer groups. Predictive analyses were used to identify ED presentation features predictive of hospital admission for cancer patients. Outcomes of interest were level of acuity, ED and inpatient length of stay, re-presentation rates and admission rates amongst cancer patients and non-cancer patients.
  
  
  RESULTS
  ED (529,377) presentations occurred over the 36 months, of which 2.4% (n = 12,489) were cancer-related. Compared with all other attendances, cancer-related attendances had a higher level of acuity, requiring longer management time and length of stay in ED. Re-presentation rates for people with cancer were nearly double those of others (64 vs 33%, p < 0.001), with twice the rate of hospital admission (90 vs 46%, p < 0.001), longer inpatient length of stay (5.6 vs 2.8 days, p < 0.001) and had higher inpatient mortality (7.9 vs 1.0%, p < 0.001). Acuity and arriving by ambulance were significant predictors of hospital admission, with cancer-related attendances having ten times the odds of admission compared to other attendances (OR = 10.4, 95% CI 9.8-11.1).
  
  
  CONCLUSIONS
  ED presentations by people with cancer represent a more urgent, complex caseload frequently requiring hospital admission when compared to other presentations, suggesting that for optimal cancer care, close collaboration and integration of oncology, palliative care and emergency medicine providers are needed to improve pathways of care.
authors: Emergency Practice Innovation Centre, St. Vincent's Hospital, PO Box 2900, Fitzroy, Melbourne, VIC, 3065, Australia.
authors: Dania M
authors: DM
authors: van der Meer
authors: Emergency Practice Innovation Centre, St. Vincent's Hospital, PO Box 2900, Fitzroy, Melbourne, VIC, 3065, Australia.|Department of Medicine, The University of Melbourne (St. Vincent's Hospital), Melbourne, Victoria, Australia.
authors: Tracey J
authors: TJ
authors: Weiland
authors: Palliative Medicine, St. Vincent's Hospital, Melbourne, Victoria, Australia.|Centre for Palliative Care, The University of Melbourne, Melbourne, Victoria, Australia.
authors: Jennifer
authors: J
authors: Philip
authors: Emergency Practice Innovation Centre, St. Vincent's Hospital, PO Box 2900, Fitzroy, Melbourne, VIC, 3065, Australia. george.jelinek@gmail.com.|Department of Medicine, The University of Melbourne (St. Vincent's Hospital), Melbourne, Victoria, Australia. george.jelinek@gmail.com.|Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia. george.jelinek@gmail.com.
authors: George A
authors: http://orcid.org/0000-0001-6157-0910
authors: GA
authors: Jelinek
authors: Palliative Medicine, St. Vincent's Hospital, Melbourne, Victoria, Australia.|Centre for Palliative Care, The University of Melbourne, Melbourne, Victoria, Australia.
authors: Mark
authors: M
authors: Boughey
authors: Emergency Department, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
authors: Jonathan
authors: J
authors: Knott
authors: Emergency Practice Innovation Centre, St. Vincent's Hospital, PO Box 2900, Fitzroy, Melbourne, VIC, 3065, Australia.
authors: Claudia H
authors: CH
authors: Marck
authors: Palliative Medicine, St. Vincent's Hospital, Melbourne, Victoria, Australia.|Centre for Palliative Care, The University of Melbourne, Melbourne, Victoria, Australia.
authors: Jennifer L
authors: JL
authors: Weil
authors: Palliative Medicine, St. Vincent's Hospital, Melbourne, Victoria, Australia.
authors: Heather P
authors: HP
authors: Lane
authors: Department of Oncology, St. Vincent's Hospital, Melbourne, Victoria, Australia.
authors: Anthony J
authors: AJ
authors: Dowling
authors: Joseph Epstein Centre for Emergency Medicine Research at Western Health, Sunshine Hospital, Victoria, Australia.
authors: Anne-Maree
authors: AM
authors: Kelly
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014739:Victoria; D055815:Young Adult
keywords: Admission; Cancer; Emergency department; Hospitalization; Mortality; Symptoms