Scott W Kirkland1, Miriam Garrido-Clua1, Daniela R Junqueira1, Sandra Campbell2, Brian H Rowe3,4. 1. Department of Emergency Medicine, Faculty of Medicine & Dentistry, University of Alberta, 1G1.43 WMC 8440-112 Street NW, Edmonton, AB, T6G 2B7, Canada. 2. J.W. Scott Health Sciences Library, University of Alberta, 2K3.28 Walter C. Mackenzie Health Sciences Centre 8440-112 Street NW, Edmonton, AB, T6G 2R7, Canada. 3. Department of Emergency Medicine, Faculty of Medicine & Dentistry, University of Alberta, 1G1.43 WMC 8440-112 Street NW, Edmonton, AB, T6G 2B7, Canada. brian.rowe@ualberta.ca. 4. School of Public Health, University of Alberta, Edmonton, AB, Canada. brian.rowe@ualberta.ca.
Abstract
PURPOSE: The objective of this scoping review was to examine the effectiveness of supportive care interventions designed to reduce ED visits among patients receiving active cancer treatment. METHODS: Literature search involving nine electronic databases and grey literature. Inclusion criteria considered studies assessing the impact of any intervention to reduce ED utilization among patients with active cancer. Dichotomous and continuous outcomes were summarized as risk ratio (RR) or mean difference (MD) with 95% confidence intervals (CIs) using a random-effects model, wherever appropriate. RESULTS: A total of 25 studies were included. Interventions identified in these studies comprised the following: routine and symptom-based patient follow-up, oncology outpatient clinics, early symptom detection, comprehensive inpatient management, hospital at home, and patient navigators. Six out of eight studies assessing oncology outpatient clinics reported a decrease in the proportion of patients presenting to the ED. A meta-analysis of three of these studies did not demonstrate reduction in ED utilization (RR 0.78; 95% CI 0.56 to 1.08; I2 = 77%) when comparing oncology outpatient clinics with standard care; however, sensitivity analysis supported a decrease in ED visits (RR 0.86; 95% CI 0.74 to 0.99; I2 = 47%). Three studies assessing patient follow-up interventions showed no difference in ED utilization (RR 0.69; 95% CI 0.38 to 1.25; I2 = 86%). CONCLUSION: A variety of supportive care interventions designed to mitigate ED presentations by patients receiving active cancer treatment have been developed and evaluated. Limited evidence suggests that an oncology outpatient clinic may be an effective strategy to reduce ED utilization; however, additional high-quality studies are needed.
PURPOSE: The objective of this scoping review was to examine the effectiveness of supportive care interventions designed to reduce ED visits among patients receiving active cancer treatment. METHODS: Literature search involving nine electronic databases and grey literature. Inclusion criteria considered studies assessing the impact of any intervention to reduce ED utilization among patients with active cancer. Dichotomous and continuous outcomes were summarized as risk ratio (RR) or mean difference (MD) with 95% confidence intervals (CIs) using a random-effects model, wherever appropriate. RESULTS: A total of 25 studies were included. Interventions identified in these studies comprised the following: routine and symptom-based patient follow-up, oncology outpatient clinics, early symptom detection, comprehensive inpatient management, hospital at home, and patient navigators. Six out of eight studies assessing oncology outpatient clinics reported a decrease in the proportion of patients presenting to the ED. A meta-analysis of three of these studies did not demonstrate reduction in ED utilization (RR 0.78; 95% CI 0.56 to 1.08; I2 = 77%) when comparing oncology outpatient clinics with standard care; however, sensitivity analysis supported a decrease in ED visits (RR 0.86; 95% CI 0.74 to 0.99; I2 = 47%). Three studies assessing patient follow-up interventions showed no difference in ED utilization (RR 0.69; 95% CI 0.38 to 1.25; I2 = 86%). CONCLUSION: A variety of supportive care interventions designed to mitigate ED presentations by patients receiving active cancer treatment have been developed and evaluated. Limited evidence suggests that an oncology outpatient clinic may be an effective strategy to reduce ED utilization; however, additional high-quality studies are needed.
Authors: Katia Noyes; Alaina L Zapf; Rachel M Depner; Tessa Flores; Alissa Huston; Hani H Rashid; Demetria McNeal; Louis S Constine; Fergal J Fleming; Gregory E Wilding; Olle Jane Z Sahler Journal: Cancer Treat Res Commun Date: 2022-03-25
Authors: Mohana Roy; Brian Halbert; Scott Devlin; David Chiu; Ryan Graue; Jessica A Zerillo Journal: Support Care Cancer Date: 2020-11-07 Impact factor: 3.603