Reducing emergency department utilization for outpatient acute cancer symptoms: An integrative review on the advent of urgent cancer clinics

Tammy L. Patel, Shelley Raffin Bouchal, Catherine M. Laing, Stephanie Hubbard

Abstract


The purpose of this integrative literature review was to identify nursing research opportunities related to outpatient acute cancer symptom management within emerging urgent cancer clinics (UCCs). Patients with acute cancer symptoms (e.g., fevers, gastrointestinal disturbances, or uncontrolled pain) from ambulatory settings predominantly rely on emergency departments (EDs) for assessment and treatment. However, this model of care is no longer sustainable and emphasizes healthcare system inefficiencies. Urgent cancer clinics allow patients to have these symptoms treated by oncology experts within ambulatory cancer centres. Unfortunately, limited research on urgent cancer clinics both operationally and experientially makes it difficult for others to adopt this new model of care. The core questions that guided this integrative review were: 1) What is the state of the science regarding UCCs, and what differences exist when compared to EDs in the management of outpatient acute cancer symptoms? and 2) Where do UCCs exist around the world, and what is understood about UCCs related to clinic operations and staffing models?


Full Text:

PDF

References


Antonuzzo, A., Vasile, E., Sbrana, A., Lucchesi, M., Galli, L., Brunetti, I. M., Musettini, G., Farnesi, A., Biasco, E., Virgili, N., Falcone, A., & Ricci, S. (2017). Impact of a supportive care service for cancer outpatients: Management and reduction of hospitalizations. Preliminary results of an integrated model of care. Supportive Care in Cancer, 25(1), 209–212. https://doi.org/10.1007/s00520-016-3403-z

Aprile, G., Pisa, F. E., Follador, A., Foltran, L., De Pauli, F., Mazzer, M., Lutrino, S., Sacco, C. S., Mansutti, M., & Fasola, G. (2013). Unplanned presentations of cancer outpatients: A retrospective cohort study. Supportive Care in Cancer, 21(2), 397–404. https://doi.org/10.1007/s00520-012-1524-6

Barbera, L., Atzema, C., Sutradhar, R., Seow, H., Howell, D., Husain, A., Sussman, J., Earle, C., Liu, Y., & Dudgeon, D. (2013). Do patient-reported symptoms predict emergency department visits in cancer patients? A population-based analysis. Annals of Emergency Medicine, 61(4), 427–437. https://doi.org/10.1016/j.annemergmed.2012.10.010

Brooks, G. A., Chen, E. J., Murakami, M. A., Giannakis, M., Baugh, C. W., & Schrag, D. (2016). An ED pilot intervention to facilitate outpatient acute care for cancer patients. American Journal of Emergency Medicine, 34(10), 1934–938. https://doi.org/10.1016/j.ajem.2016.06.076

Canadian Cancer Statistics Advisory Committee. (2019). Canadian cancer statistics 2019. Canadian Cancer Society. https://www.cancer.ca/~/media/cancer.ca/CW/cancer%20information/cancer%20101/Canadian%20cancer%20statistics/Canadian-Cancer-Statistics-2019-EN.pdf?la=en

Clarke, R. T., Bird, S., Kakuchi, I., Littlewood, T. J., & van Hamel Parsons, V. (2015). The signs, symptoms and help-seeking experiences of neutropenic sepsis patients before they reach hospital: A qualitative study. Supportive Care in Cancer, 23(9), 2687–2694. https://doi.org/10.1007/s00520-015-2631-y

Colligan, E. M., Ewald, E., Keating, N. L., Parashuram, S., Spafford, M., Ruiz, S., & Moiduddin, A. (2017). Two innovative cancer care programs have potential to reduce utilization and spending. Medical Care, 55(10), 873–878. https://doi.org/10.1097/MLR.0000000000000795

Cooksley, T., & Rice, T. (2017). Emergency oncology: Development, current position and future direction in the USA and UK. Supportive Care in Cancer, 25(1), 3–7. https://doi.org/10.1007/s00520-016-3470-1

Coyle, Y. M., Miller, A. M., & Paulson, R. S. (2013). Model for the cost-efficient delivery of continuous quality cancer care: A hospital and private-practice collaboration. Baylor University Medical Center Proceedings, 26(2), 9599. https://www.ncbi.nlm.nih.gov/pubmed/23543960

Hassett, M. J., O’Malley, A. J., Pakes, J. R., Newhouse, J. P., & Earle, C. C. (2006). Frequency and cost of chemotherapy-related serious adverse effects in a population sample of women with breast cancer. Journal of the National Cancer Institute, 98(16), 1108–1117. https://doi.org/10.1093/jnci/djj305

Kuo, J. C., De Silva, M., Diwakarla, C., & Yip, D. (2017). A Rapid Access Clinic to improve delivery of ambulatory care to cancer patients. Asia-Pacific Journal of Clinical Oncology, 13(3), 179–184. https://doi.org/10.1111/ajco.12641

Livingston, P. M., Craike, M., & Considine, J. (2011). Unplanned presentations to emergency departments due to chemotherapy induced complications: Opportunities for improving service delivery. Australasian Emergency Nursing Journal, 14(2), 62–68.

Majem, M., Galán, M., Pérez, F. J., Muñoz, M., Chicote, S., Soler, G., Navarro, M., Martínez-Villacampa, M., García del Muro, X., Dotor, E., Laquente, B., & Germà, J. R. (2007). The Oncology Acute Toxicity Unit (OATU): An outpatient facility for improving the management of chemotherapy toxicity. Clinical and Translational Oncology, 9(12), 784–788.

Mason, H., DeRubeis, M. B., Foster, J. C., Taylor, J. M., & Worden, F. P. (2013). Outcomes evaluation of a weekly nurse practitioner-managed symptom management clinic for patients with head and neck cancer treated with chemoradiotherapy. Oncology Nursing Forum, 40(6), 581–586. https://doi.org/10.1188/13.ONF.40-06AP

Mayer, D. K., Travers, D., Wyss, A., Leak, A., & Waller, A. (2011). Why do patients with cancer visit emergency departments? Results of a 2008 population study in North Carolina. Journal of Clinical Oncology, 29(19), 2683–2688. https://doi.org/10.1200/jco.2010.34.2816

McKenzie, H., Hayes, L., White, K., Cox, K., Fethney, J., Boughton, M., & Dunn, J. (2011). Chemotherapy outpatients’ unplanned presentations to hospital: A retrospective study. Supportive Care in Cancer, 19(7), 963–969. https://doi.org/10.1007/s00520-010-0913-y

Meisenberg, B. R., Graze, L., & Brady-Copertino, C. J. (2014). A supportive care clinic for cancer patients embedded within an oncology practice. The Journal of Community and Supportive Oncology, 12(6), 205–208.

Prystajecky, M., Lang, E., Wang, D., Simon, J., Sinnarajah, A., Martin, T. L. W., Murray, A., Hagen, N., Waller, A., Bultz, B., Carlson, L., Groff, S., McRae, A., Thomas, B. (2012). Emergency department utilization by adult cancer patients: A prospective cohort study. Academic Emergency Medicine, 19, S225–S226.

Ruegg, T. A. (2013). A nurse practitioner-led urgent care center: Meeting the needs of the patient with cancer. Clinical Journal of Oncology Nursing, 17(4), E52–E57. https://doi.org/10.1188/13.CJON.E52-E57

Schlamb, T. (2014). Urgent cancer care and the cancer helpline. http://www.cancercare.mb.ca/resource/File/MBWCN/presenations/Urgent_Care_Presentation-Tracy_Schlamb.pdf

Sitzes-Determann, A. L. (2009). Planning for the sustainment of a 24/7 oncology clinic: An action and evaluation research project. (Doctoral dissertation). http://ezproxy.lib.ucalgary.ca/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=109853890&site=ehost-live

Specialist Unit for Review of Evidence (SURE). (2018a). Questions to assist with the critical appraisal of cohort studies. https://www.cardiff.ac.uk/__data/assets/pdf_file/0006/1142997/SURE-CA-form-for-Cohort_2018.pdf

Specialist Unit for Review of Evidence (SURE). (2018b). Questions to assist with the critical appraisal of qualitative studies. https://www.cardiff.ac.uk/__data/assets/pdf_file/0007/1142971/SURE-CA-form-for-Qualitative_2018.pdf

Trip, K., Boloorchi, A., & Berman, H. (2011). Utilizing the Canadian emergency department Triage and Acuity Scale (CTAS) in an oncology urgent care clinic: The university health network experience. Canadian Oncology Nursing Journal, 21(1), 52–57. https://www.ncbi.nlm.nih.gov/pubmed/21462878

van der Meer, D. M., Weiland, T. J., Philip, J., Jelinek, G. A., Boughey, M., Knott, J., Marck, C. H., Weil, J. L., Lane, H. P., Dowling, A. J., & Kelly, A. M. (2016). Presentation patterns and outcomes of patients with cancer accessing care in emergency departments in Victoria, Australia. Supportive Care in Cancer, 24(3), 1251–1260. https://doi.org/10.1007/s00520-015-2921-4

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. Supportive Care in Cancer, 20(8), 1589–1599. https://doi.org/10.1007/s00520-012-1459-y

Whittemore, R., & Knafl, K. (2005). The integrative review: updated methodology. Journal of Advanced Nursing, 52(5), 546–553. https://doi.org/10.1111/j.1365-2648.2005.03621.x

Young, A., Marshall, E., Krzyzanowska, M., Robinson, B., Brown, S., Collinson, F., Seligmann, J., Abbas, A., Rees, A., Swinson, D., Neville-Webbe, H., & Selby, P. (2016). Responding to acute care needs of patients with cancer: Recent trends across continents. The Oncologist, 21(3), 301–307. https://doi.org/10.1634/theoncologist.2014-0341


Refbacks

  • There are currently no refbacks.


Bookmark and Share