Demis N Lipe1, Ahmed Elsayem2, Maria T Cruz-Carreras2, Jomol Thomas2, Adianes Feliciano3, Jenny Ren4, Susan M Gaeta2, Eva Rajha2, Elisabet Manasanch5, Ed Kheder6, Patricia Brock2, Cielito Reyes-Gibby7. 1. Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. dnlipe@mdanderson.org. 2. Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. 3. Department of Emergency Medicine, Baylor College of Medicine, Houston, TX, USA. 4. Baylor College of Medicine, Houston, TX, USA. 5. Department of LymphomaMyeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. 6. Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. 7. Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Abstract
BACKGROUND: Cancer patients are vulnerable to the coronavirus disease (COVID-19) given their compromised immune system. The purpose of this study was to describe the presenting symptoms, inpatient stay trajectory, and survival outcomes, for cancer patients infected with COVID-19; who presented to the emergency department (ED) of a single center during the early months of the pandemic. METHODS: We reviewed the electronic medical records of all cancer patients diagnosed with COVID-19 at our institution for demographic information, clinical presentation, laboratory findings, treatment intervention and outcomes. All patients had at least 14 days of follow-up. We determined their survival outcomes as of August 5, 2020. RESULTS: Twenty-eight cancer patients were diagnosed with COVID-19, and 16 (57%) presented to the ED during the study period. The median age of patients who presented to the ED was 61 years, 69% were women, and the median length of hospitalization was 11 days. There was no difference between the groups (ED vs. no ED visit) for demographics, treatment status or solid tumor versus hematologic malignancies or treatments. Dyspnea was a significant symptom with 67% of ED patients experiencing it versus only 17% of those that did not come to the ED (P=0.009). Do not resuscitate orders were initiated in eight patients, as early as two days from ED presentation and two of these patients died, while 88% of patients were discharged alive. CONCLUSIONS: Most cancer patients with COVID-19 infection admitted though the ED experienced dyspnea and were discharged from the hospital. We did not notice a statistically significant difference between cancer types or type of therapy. A broad differential is of utmost importance when caring for cancer patients with COVID-19 due to the complexity of this population. Early goals of care discussion should be initiated in the ED.
BACKGROUND:Cancerpatients are vulnerable to the coronavirus disease (COVID-19) given their compromised immune system. The purpose of this study was to describe the presenting symptoms, inpatient stay trajectory, and survival outcomes, for cancerpatientsinfected with COVID-19; who presented to the emergency department (ED) of a single center during the early months of the pandemic. METHODS: We reviewed the electronic medical records of all cancerpatients diagnosed with COVID-19 at our institution for demographic information, clinical presentation, laboratory findings, treatment intervention and outcomes. All patients had at least 14 days of follow-up. We determined their survival outcomes as of August 5, 2020. RESULTS: Twenty-eight cancerpatients were diagnosed with COVID-19, and 16 (57%) presented to the ED during the study period. The median age of patients who presented to the ED was 61 years, 69% were women, and the median length of hospitalization was 11 days. There was no difference between the groups (ED vs. no ED visit) for demographics, treatment status or solid tumor versus hematologic malignancies or treatments. Dyspnea was a significant symptom with 67% of ED patients experiencing it versus only 17% of those that did not come to the ED (P=0.009). Do not resuscitate orders were initiated in eight patients, as early as two days from ED presentation and two of these patientsdied, while 88% of patients were discharged alive. CONCLUSIONS: Most cancerpatients with COVID-19infection admitted though the ED experienced dyspnea and were discharged from the hospital. We did not notice a statistically significant difference between cancer types or type of therapy. A broad differential is of utmost importance when caring for cancerpatients with COVID-19 due to the complexity of this population. Early goals of care discussion should be initiated in the ED.
Entities:
Keywords:
COVID-19; Cancer; SARS-CoV-2; do not resuscitate; emergency department (ED); end of life care
Authors: Demis N Lipe; Sorayah S Bourenane; Monica K Wattana; Susan Gaeta; Patrick Chaftari; Maria T Cruz Carreras; Joanna-Grace Manzano; Cielito Reyes-Gibby Journal: Am J Emerg Med Date: 2022-02-05 Impact factor: 4.093