TY - JOUR
T1 - Cancer pain management in the emergency department
T2 - a multicenter prospective observational trial of the Comprehensive Oncologic Emergencies Research Network (CONCERN)
AU - Coyne, Christopher J.
AU - Reyes-Gibby, Cielito C.
AU - Durham, Danielle D.
AU - Abar, Beau
AU - Adler, David
AU - Bastani, Aveh
AU - Bernstein, Steven L.
AU - Baugh, Christopher W.
AU - Bischof, Jason J.
AU - Grudzen, Corita R.
AU - Henning, Daniel J.
AU - Hudson, Matthew F.
AU - Klotz, Adam
AU - Lyman, Gary H.
AU - Madsen, Troy E.
AU - Pallin, Daniel J.
AU - Rico, Juan Felipe
AU - Ryan, Richard J.
AU - Shapiro, Nathan I.
AU - Swor, Robert
AU - Thomas, Charles R.
AU - Venkat, Arvind
AU - Wilson, Jason
AU - Yeung, Sai Ching Jim
AU - Caterino, Jeffrey M.
N1 - Publisher Copyright:
© 2021, The Author(s), under exclusive licence to Springer-Verlag GmbH, DE part of Springer Nature.
PY - 2021/8
Y1 - 2021/8
N2 - Purpose: Many patients with cancer seek care for pain in the emergency department (ED). Prospective research on cancer pain in this setting has historically been insufficient. We conducted this study to describe the reported pain among cancer patients presenting to the ED, how pain is managed, and how pain may be associated with clinical outcomes. Methods: We conducted a multicenter cohort study on adult patients with active cancer presenting to 18 EDs in the USA. We reported pain scores, response to medication, and analgesic utilization. We estimated the associations between pain severity, medication utilization, and the following outcomes: 30-day mortality, 30-day hospital readmission, and ED disposition. Results: The study population included 1075 participants. Those who received an opioid in the ED were more likely to be admitted to the hospital and were more likely to be readmitted within 30 days (OR 1.4 (95% CI: 1.11, 1.88) and OR 1.56 (95% CI: 1.17, 2.07)), respectively. Severe pain at ED presentation was associated with increased 30-day mortality (OR 2.30, 95% CI: 1.05, 5.02), though this risk was attenuated when adjusting for clinical factors (most notably functional status). Conclusions: Patients with severe pain had a higher risk of mortality, which was attenuated when correcting for clinical characteristics. Those patients who required opioid analgesics in the ED were more likely to require admission and were more at risk of 30-day hospital readmission. Future efforts should focus on these at-risk groups, who may benefit from additional services including palliative care, hospice, or home-health services.
AB - Purpose: Many patients with cancer seek care for pain in the emergency department (ED). Prospective research on cancer pain in this setting has historically been insufficient. We conducted this study to describe the reported pain among cancer patients presenting to the ED, how pain is managed, and how pain may be associated with clinical outcomes. Methods: We conducted a multicenter cohort study on adult patients with active cancer presenting to 18 EDs in the USA. We reported pain scores, response to medication, and analgesic utilization. We estimated the associations between pain severity, medication utilization, and the following outcomes: 30-day mortality, 30-day hospital readmission, and ED disposition. Results: The study population included 1075 participants. Those who received an opioid in the ED were more likely to be admitted to the hospital and were more likely to be readmitted within 30 days (OR 1.4 (95% CI: 1.11, 1.88) and OR 1.56 (95% CI: 1.17, 2.07)), respectively. Severe pain at ED presentation was associated with increased 30-day mortality (OR 2.30, 95% CI: 1.05, 5.02), though this risk was attenuated when adjusting for clinical factors (most notably functional status). Conclusions: Patients with severe pain had a higher risk of mortality, which was attenuated when correcting for clinical characteristics. Those patients who required opioid analgesics in the ED were more likely to require admission and were more at risk of 30-day hospital readmission. Future efforts should focus on these at-risk groups, who may benefit from additional services including palliative care, hospice, or home-health services.
KW - Acute care
KW - ED
KW - Emergency department
KW - Pain management
KW - Palliative care
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U2 - 10.1007/s00520-021-05987-3
DO - 10.1007/s00520-021-05987-3
M3 - Article
C2 - 33483789
AN - SCOPUS:85099844070
SN - 0941-4355
VL - 29
SP - 4543
EP - 4553
JO - Supportive Care in Cancer
JF - Supportive Care in Cancer
IS - 8
ER -