Please use this identifier to cite or link to this item: https://doi.org/10.1002/cam4.1728
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dc.titleCancer patients as frequent attenders in emergency departments: A national cohort study
dc.contributor.authorWong T.H.
dc.contributor.authorLau Z.Y.
dc.contributor.authorOng W.S.
dc.contributor.authorTan K.B.
dc.contributor.authorWong Y.J.
dc.contributor.authorFarid M.
dc.contributor.authorTeo M.C.C.
dc.contributor.authorYee A.C.P.
dc.contributor.authorNguyen H.V.
dc.contributor.authorOng M.E.H.
dc.contributor.authorIyer N.G.
dc.date.accessioned2020-09-09T03:08:12Z
dc.date.available2020-09-09T03:08:12Z
dc.date.issued2018
dc.identifier.citationWong 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
dc.identifier.issn20457634
dc.identifier.urihttps://scholarbank.nus.edu.sg/handle/10635/175045
dc.description.abstractBackground: 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.
dc.sourceUnpaywall 20200831
dc.subjectadolescent
dc.subjectadult
dc.subjectage
dc.subjectaged
dc.subjectArticle
dc.subjectbone metastasis
dc.subjectbrain cancer
dc.subjectbrain metastasis
dc.subjectcancer patient
dc.subjectCharlson Comorbidity Index
dc.subjectcohort analysis
dc.subjectcontrolled study
dc.subjectdigestive system cancer
dc.subjectdisease association
dc.subjectemergency care
dc.subjectemergency ward
dc.subjectesophagus cancer
dc.subjectfemale
dc.subjectgender
dc.subjecthead and neck cancer
dc.subjecthealth care utilization
dc.subjecthematologic malignancy
dc.subjecthepatopancreas
dc.subjecthigh risk patient
dc.subjecthospital discharge
dc.subjecthospitalization
dc.subjecthousing
dc.subjecthuman
dc.subjecthypopharynx cancer
dc.subjectliver cancer
dc.subjectliver metastasis
dc.subjectlung cancer
dc.subjectlung metastasis
dc.subjectlymphatic leukemia
dc.subjectmajor clinical study
dc.subjectmale
dc.subjectmedical record review
dc.subjectmiddle aged
dc.subjectmortality
dc.subjectnonhodgkin lymphoma
dc.subjectpancreas cancer
dc.subjectpleura cancer
dc.subjectpriority journal
dc.subjectpublic hospital
dc.subjectretrospective study
dc.subjectSingapore
dc.subjectsocioeconomics
dc.subjectspine cancer
dc.subjectstomach cancer
dc.subjecttongue cancer
dc.subjecttrachea cancer
dc.subjectyoung adult
dc.subjectambulatory care
dc.subjectcomorbidity
dc.subjectemergency health service
dc.subjecthospital emergency service
dc.subjectincidence
dc.subjectneoplasm
dc.subjectpatient attitude
dc.subjectrisk factor
dc.subjectvery elderly
dc.subjectAdolescent
dc.subjectAdult
dc.subjectAged
dc.subjectAged, 80 and over
dc.subjectAmbulatory Care
dc.subjectComorbidity
dc.subjectEmergency Medical Services
dc.subjectEmergency Service, Hospital
dc.subjectFemale
dc.subjectHospitalization
dc.subjectHumans
dc.subjectIncidence
dc.subjectMale
dc.subjectMiddle Aged
dc.subjectNeoplasms
dc.subjectPatient Acceptance of Health Care
dc.subjectRetrospective Studies
dc.subjectRisk Factors
dc.subjectYoung Adult
dc.typeArticle
dc.contributor.departmentDUKE-NUS MEDICAL SCHOOL
dc.description.doi10.1002/cam4.1728
dc.description.sourcetitleCancer Medicine
dc.description.volume7
dc.description.issue9
dc.description.page4434-4446
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