Oncologic emergencies and urgencies: A comprehensive review.
Bonnie E Gould RothbergTammie E QuestSai-Ching J YeungLorraine C PelosofDavid E GerberJustin A SeltzerJason J BischofCharles R ThomasNausheen AkhterMira MamtaniRobin E StutmanChristopher W BaughVenkataraman AnantharamanNicholas R PettitAdam D KlotzMichael A GibbsDemetrios N KyriacouPublished in: CA: a cancer journal for clinicians (2022)
Patients with advanced cancer generate 4 million visits annually to emergency departments (EDs) and other dedicated, high-acuity oncology urgent care centers. Because of both the increasing complexity of systemic treatments overall and the higher rates of active therapy in the geriatric population, many patients experiencing acute decompensations are frail and acutely ill. This article comprehensively reviews the spectrum of oncologic emergencies and urgencies typically encountered in acute care settings. Presentation, underlying etiology, and up-to-date clinical pathways are discussed. Criteria for either a safe discharge to home or a transition of care to the inpatient oncology hospitalist team are emphasized. This review extends beyond familiar conditions such as febrile neutropenia, hypercalcemia, tumor lysis syndrome, malignant spinal cord compression, mechanical bowel obstruction, and breakthrough pain crises to include a broader spectrum of topics encompassing the syndrome of inappropriate antidiuretic hormone secretion, venous thromboembolism and malignant effusions, as well as chemotherapy-induced mucositis, cardiomyopathy, nausea, vomiting, and diarrhea. Emergent and urgent complications associated with targeted therapeutics, including small molecules, naked and drug-conjugated monoclonal antibodies, as well as immune checkpoint inhibitors and chimeric antigen receptor T-cells, are summarized. Finally, strategies for facilitating same-day direct admission to hospice from the ED are discussed. This article not only can serve as a point-of-care reference for the ED physician but also can assist outpatient oncologists as well as inpatient hospitalists in coordinating care around the ED visit.
Keyphrases
- palliative care
- chemotherapy induced
- advanced cancer
- emergency department
- acute care
- spinal cord
- venous thromboembolism
- end stage renal disease
- healthcare
- case report
- chronic kidney disease
- primary care
- ejection fraction
- neuropathic pain
- spinal cord injury
- heart failure
- rectal cancer
- liver failure
- peritoneal dialysis
- photodynamic therapy
- pain management
- radical prostatectomy
- mental health
- radiation therapy
- intensive care unit
- robot assisted
- prognostic factors
- direct oral anticoagulants
- atrial fibrillation
- bone marrow
- affordable care act
- quality improvement
- adverse drug
- cell therapy
- abdominal pain
- patient reported
- mechanical ventilation