Please use this identifier to cite or link to this item: https://doi.org/10.1002/cam4.1728
Title: Cancer patients as frequent attenders in emergency departments: A national cohort study
Authors: Wong T.H. 
Lau Z.Y.
Ong W.S.
Tan K.B.
Wong Y.J.
Farid M. 
Teo M.C.C. 
Yee A.C.P. 
Nguyen H.V.
Ong M.E.H. 
Iyer N.G. 
Keywords: adolescent
adult
age
aged
Article
bone metastasis
brain cancer
brain metastasis
cancer patient
Charlson Comorbidity Index
cohort analysis
controlled study
digestive system cancer
disease association
emergency care
emergency ward
esophagus cancer
female
gender
head and neck cancer
health care utilization
hematologic malignancy
hepatopancreas
high risk patient
hospital discharge
hospitalization
housing
human
hypopharynx cancer
liver cancer
liver metastasis
lung cancer
lung metastasis
lymphatic leukemia
major clinical study
male
medical record review
middle aged
mortality
nonhodgkin lymphoma
pancreas cancer
pleura cancer
priority journal
public hospital
retrospective study
Singapore
socioeconomics
spine cancer
stomach cancer
tongue cancer
trachea cancer
young adult
ambulatory care
comorbidity
emergency health service
hospital emergency service
incidence
neoplasm
patient attitude
risk factor
very elderly
Adolescent
Adult
Aged
Aged, 80 and over
Ambulatory Care
Comorbidity
Emergency Medical Services
Emergency Service, Hospital
Female
Hospitalization
Humans
Incidence
Male
Middle Aged
Neoplasms
Patient Acceptance of Health Care
Retrospective Studies
Risk Factors
Young Adult
Issue Date: 2018
Citation: Wong T.H., Lau Z.Y., Ong W.S., Tan K.B., Wong Y.J., Farid M., Teo M.C.C., Yee A.C.P., Nguyen H.V., Ong M.E.H., Iyer N.G. (2018). Cancer patients as frequent attenders in emergency departments: A national cohort study. Cancer Medicine 7 (9) : 4434-4446. ScholarBank@NUS Repository. https://doi.org/10.1002/cam4.1728
Abstract: Background: Cancer patients contribute significantly to emergency department (ED) utilization. The objective of this study was to identify factors associated with patients becoming ED frequent attenders (FA) after a cancer-related hospitalization. Methods: A retrospective cohort study was conducted using national administrative, billing, and death records of Singapore residents discharged alive from Singapore public hospitals from January 2012 to December 2015, with a primary discharge diagnosis of cancer. Patients with four or more ED visits within any 12-month period after discharge from their index hospitalization were classified as FA. Time to FA distribution was estimated using the Kaplan-Meier method, and factors associated with risk of FA were identified using multivariate Cox regression analyses. Results: Records for 47 235 patients were analyzed, of whom 2980 patients were FA within the study period. Age (<17 years, hazard ratio [HR] 2.92, 95% CI 2.28-3.74; 75-84 years, HR 1.29, 95% CI 1.16-1.45; and ?85 years, HR 1.71, 95% CI 1.45-2.02, relative to age 55-64), male gender (HR 1.26, 95% CI 1.16-1.37), Charlson comorbidity index (HR 1.21, 95% CI 1.19-1.23), and socioeconomic factors (Medifund use, HR 1.40, 95% CI 1.23-1.59; housing subsidy type, HR 2.12, 95% CI 1.77-2.54) were associated with increased risk of FA. Primary malignancies associated with FA included brain and spine (HR 2.51, 95% CI 1.67-3.75), head and neck cancers (tongue, HR 2.05, 95% CI 1.27-3.31; hypopharynx, HR 2.72, 95% CI 1.56-4.74), lung (trachea and lung, HR 1.57, 95% CI 1.13-2.18; pleural, HR 3.69, 95% CI 2.12-6.34), upper gastrointestinal (stomach, HR 1.93, 95% CI 1.26-2.74; esophagus, HR 4.13, 95% CI 2.78-6.13), hepato-pancreato-biliary (liver, HR 1.42, 95% CI 1.01-2.00, pancreas, HR 2.48, 95% CI 1.72-3.59), and certain hematological malignancies (diffuse non-Hodgkin's lymphoma, HR1.59, 95% CI 1.08-2.33, lymphoid leukemia, HR 1.86, 95% CI 1.21-2.86). Brain (HR 1.69, 95% CI 1.27-2.26), lung (HR 1.31, 95% CI 1.01-1.71), liver (HR 1.46, 95% CI 1.14-1.89), and bone (HR 1.35, 95% CI 1.04-1.76) metastases were also associated with FA. Conclusion: There are cancer-specific factors contributing to ED frequent attendance. Additional resources should be allocated to support high-risk groups and prevent unnecessary ED use. © 2018 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.
Source Title: Cancer Medicine
URI: https://scholarbank.nus.edu.sg/handle/10635/175045
ISSN: 20457634
DOI: 10.1002/cam4.1728
Appears in Collections:Elements
Staff Publications

Show full item record
Files in This Item:
File Description SizeFormatAccess SettingsVersion 
10_1002_cam4_1728.pdf1.48 MBAdobe PDF

OPEN

NoneView/Download

SCOPUSTM   
Citations

6
checked on Nov 27, 2020

Page view(s)

21
checked on Nov 27, 2020

Google ScholarTM

Check

Altmetric


Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.