Acil Servise Başvuran Kanser Hastalarının Klinik, Demografik Özellikleri ve Kısa Dönem Prognozu

Yıl 2024, Cilt: 6 Sayı: 2, 284 - 293, 22.08.2024

Şimşek Çelik , Pelin Çelik

https://doi.org/10.46413/boneyusbad.1433221

Öz

Amaç: Bu çalışmanın amacı, acil servise başvuran kanser hastalarının demografik bulgularını, klinik özelliklerini, kısa dönem mortalite/ mortaliteyi etkileyen faktörleri belirlemektir.
Gereç ve Yöntem: Bu çalışma kesitsel ve retrospektif bir araştırmadır. Bu çalışma kanser tanısı olup, acil servise başvuran 204 hasta ile gerçekleştirildi. Hastaların, klinik, demografik özellikleri, kısa dönem mortalite durumları incelendi.
Bulgular: Çalışma, yaş ortalaması 62.63 ± 14.16 yıl olan, 111'i (%54.4) erkek ve 93'ü (%45.6) kadın olmak üzere toplam 204 hasta ile gerçekleştirilmiştir. Altı hasta hematolojik malignite ve 198 hasta (%97.1) solid malignite ile başvurmuştur. ≥3 komorbiditesi olan hasta sayısı 28 (%13.7) hasta iken, en yaygın başvuru şikayeti gastrointestinal problemler (%26) olmuştur. En sık görülen performans skoru 85 (%41.7) hasta ile 3 iken, performans skoru 4 olan sadece 20 hasta tespit edilmiştir. Hastaların 85’i (%41.7) hastaneye yatırılmıştır. Acil serviste 9 (%4.4) hastada, 1 hafta içinde 22 hastada (%10.8) ve 28 gün içinde ise 33 hastada (%16.2) mortalite gözlenmiştir. Performans skoru 4 olan kanser hastalarında mortalite oranı 1. hafta sonunda %75, 28 gün sonunda ise %90 olarak bulunmuştur. Birden fazla başvuru, performans skorunun 4, ≥3 sayıda komorbidite ve metastaz olması 1 hafta ve 28 günlük sağkalımın anlamlı belirleyicileri olarak bulunmuştur.
Sonuç: Kanser hastalarının mortalitesi yüksek olup, mortaliteyi etkileyen faktörler tespit edilmiştir. Bu sonuçlar, acil serviste kanserli hastaların bakım ihtiyaçlarını belirlemeyi amaçlayan algoritmaların geliştirilmesi için önemli bilgiler sağlayabilir.

Anahtar Kelimeler

Kanser, Acil Servis, Prognoz

Clinical, Demographic Characteristics and Short-Term Prognosis of Cancer Patients Presenting to the Emergency Department

Öz

Aim: The aim of this study was to determine the demographic findings, clinical features, short-term mortality/ factors affecting mortality in cancer patients admitted to the emergency department.
Material and Method: This is a cross-sectional and retrospective study. This study was carried out with 204 patients with a diagnosis of cancer who presented to the emergency department. Clinical and demographic characteristics and short-term mortality status of the patients were analysed.
Results: The study was conducted with a total of 204 patients, 111 (54.4%) males and 93 (45.6%) females, with a mean age of 62.63 ± 14.16 years. Six patients presented with hematologic malignancy and 198 patients (97.1%) presented with solid malignancy. The number of patients with ≥3 comorbidities was 28 (13.7%) and the most common presenting complaint was gastrointestinal problems (26%). The most common performance score was 3 in 85 (41.7%) patients, while only 20 patients with a performance score of 4 were identified. Eighty-five (41.7%) of the patients were hospitalized. Mortality was observed in 9 patients (4.4%) in the emergency department, 22 patients (10.8%) within 1 week and 33 patients (16.2%) within 28 days. In cancer patients with a performance score of 4, the mortality rate was 75% at the end of week 1 and 90% at the end of 28 days. Multiple admissions, performance score 4, ≥3 comorbidities and metastasis were found to be significant predictors of 1-week and 28-day survival.
Conclusion: Mortality of cancer patients is high, and factors affecting mortality have been identified. These conclusions may provide significant pieces of information regarding the development of algorithms designed to determine the care needs of cancer patients in the Emergency Department.

Anahtar Kelimeler

Cancer, Emergency Department, Prognosis

Kaynakça

• Bozdemir, N., Eray, O., Eken, C., Şenol, Y., Artac, M., Samur, M. (2009). Demographics, Clinical Presentations and Outcomes of Cancer Patients Admitting to Emergency Department. Turkish Journal of Medical Sciences, 39(2):235-240.
• Carrillo-Estrada, M., Bobrowski, D., Carrasco, R., Nadler, M. B., Kalra, S., Thavendiranathan, P., Abdülkadir, H. (2021). Coronary artery disease in patients with cancer: challenges and opportunities for improvement. Current Opinion in Cardiology. 36 (5):597-08.
• Caterino, J. M., Adler, D., Durham, D. D., Yeung, S. C. J., Hudson, M. F., Bastani, A., … Lyman, G.H. (2019). Analysis of diagnoses, symptoms, medications, and admissions among patients with cancer presenting to emergency departments. JAMA Network Open. 2 (3):e190979- e190979.
• Chen, B., Kanaan, C., Jaiyesimi, I., Ezekwudo, D., Swor, R. (2020). Clinical characteristics of patients with cancer presenting to the emergency department and their use of emergency medical service transport. Prehospital Emergency. 24 (6):813-21.
• de Santis, R. B., Wainstein, A. J. A., Machado, G. C. O. G., Santos, F. A. V., Melo, M. R. P., Drummond-Lage, A. P. (2022). Cancer patients admitted in the emergency department: A single‐centre observational study. European Journal of Cancer Care. 31 (6):e13758.
• Fauvel, D. A., Bischof, J. J., Reinbolt, R. E., Weihing, V. K., Boyer, E. W., Caterino, J. M., Wang, H. E. (2023). Diagnosis of cancer in the Emergency Department: A scoping review. Cancer Medicine. 12 (7):8710-28.
• Fowler, H., Belot, A., Ellis, L., Maringe, C., Luque-Fernandez, M., Njagi, E. N., … Rachet, B. (2020). Comorbidity prevalence among cancer patients: a population-based cohort study of four cancers. BMC cancer. 20 (1):1-15.
• Gallaway, M.S., Idaikkadar, N., Tai, E., Momin, B., Rohan, E.A., Townsend, J., … Stewart S. (2021). Emergency department visits among people with cancer: Frequency, symptoms, and characteristics. Journal of the American College of Emergency Physicians. 3: e12438.
• Hsu, J., Donnelly, J.P., Moore, J.X., Meneses, K., Williams, G., Wang, H.E. (2018). National characteristics of emergency department visits by patients with cancer in the United States. American Journal of Emergency Medicine. 36:2038–43.
• Kim, Y. J., Seo, D. W., Kim, W. Y. (2021). Types of cancer and outcomes in patients with cancer requiring admission from the emergency department: A nationwide, population‐based study, 2016‐2017. Cancer. 127 (14):2553-61.
• Koch, M., Varga, C., Soós, V., Prenek, L., Porcsa, L., Szakall A, … Pozsgai, E. (2022). Main reasons and predictive factors of cancer-related emergency department visits in a Hungarian tertiary care center. BMC Emergency Medicine. 22 (1):1-13.
• Lash, R. S., Bell, J. F., Reed, S. C., Pogosyan, H., Rodgers, J., Kim, K. K., … Joseph, J. G., (2017). A systematic review of emergency department use among cancer patients. Cancer Nursing. 40: 135-44
• Lee, S. Y., Ro, Y. S., Shin, S. D., Moon, S. (2021). Epidemiologic trends in cancer-related emergency department utilization in Korea from 2015 to 2019. Scientific Reports. 11(1):21981. https://doi.org/10.1038/ s41598-021-01571-1
• McArdle, C. S., Hole, D. J. (2004). Emergency presentation of colorectal cancer is associated with poor 5-year survival. Journal of British Surgery, 91(5):605-609.
• Min, H. S., Chang, H. J., Sung, H. K. (2022). Emergency department utilization of adult cancer patient in Korea: a nationwide population-based study, 2017-2019. Cancer Research Treatment: Official Journal of Korean Cancer Association. 54 (3):680-89.
• Panigrahi, G., Ambs, S. (2021). How comorbidities shape cancer biology and survival. Trends in cancer. 7 (6):488-95.
• Peyrony, O., Fontaine, J. P., Beaune, S., Khoury, A., Truchot, J., Balen, F., … Chevret, S. (2020). EPICANCER-cancer patients presenting to the emergency departments in France: a prospective nationwide study. Journal of Clinical Medicine 9:1505.
• Polednak, A. P. (2000). Inpatient hospital admission through an emergency department in relation to stage at diagnosis of colorectal cancer. Cancer detection and prevention, 24(3):283-289.
• Rivera, D. R., Gallicchio, L., Brown, J., Liu, B., Kyriacou, D. N., Shelburne, N. (2017). Trends in adult cancer-related emergency department utilization: an analysis of data from the nationwide emergency department sample. JAMA Oncology. 3:e172450.
• Sarfati, D., Gurney, J., Lim, B. T., Bagheri, N., Simpson, A., Koea, J., Dennett, E. (2016). Identifying important comorbidity among cancer populations using administrative data: Prevalence and impact on survival. Asia-Pacific Journal of Clinical Oncology. 12: e47-56.
• Scholer, A. J., Mahmoud, O. M., Ghosh, D., Schwartzman, J., Farooq, M., Cabrera, J., … Chokshi, R. J. (2017). Improving cancer patient emergency room utilization: a New Jersey state assessment. Cancer Epidemiology. 51:15–22.
• Vandyk, A. D., Harrison, M. B., Macartney, G., Ross-White, A., Stacey, D. (2012). Emergency department visits for symptoms experienced by oncology patients: a systematic review. Support Care Cancer. 20 (8):1589-99. doi:10.1007/s00520-012-1459-y