Emergency Room Visits by Cancer Patients Often Preventable: Study

As efforts to combat the opioid crisis resulted in stricter prescribing, cancer pain patients often pay the price, researchers warn

More than half of emergency room visits by cancer patients could be avoided, according to the findings of a new study that suggests the treatments often result from a failure to properly manage their pain.

The number of emergency room visits due to pain more than doubled from 2012 to 2019, as the opioid epidemic worsened and restrictions were placed on prescriptions for the addictive painkillers, according to a report published on January 19 in the journal JAMA Network Open.

A team of cancer researchers from the Moffitt Cancer Center in Florida conducted a cross-sectional study of more than 854 million visits to the emergency room, including 35 million ER visits among patients with cancer. The study used data from the National Hospital Ambulatory Medical Care Survey.

Among cancer patients who visited the ER, 52% of the treatments were identified as potentially preventable. Among those patients, 21% were considered high-acuity; patients who were recovering from a serious illness or injury and needed special supervision.

From 2012–2019, the number of potentially preventable ER visits among patients with cancer increased from approximately 1.8 million to 3.2 million.

The most common reason for preventable ER visits included pain, which accounted for 37% of visits overall. The number of patients who visited the ER for pain reasons increased from 1.1 million in 2012 to 2.4 million in 2019 an increase of 102%.

More than 30% of preventable ER visits resulted in unplanned hospitalizations. That rate remained steady from 32% in 2012 to 27% in 2019, dipping only slightly.

Patients who were residents in a nursing home or had other health conditions had a higher likelihood of having potentially preventable ER visits.

Cancer-Related Pain ER Visits Increased As Opioid Prescribing Tightened

One reason for the increase in ER visits for cancer-related pain may stem from recent efforts to decrease opioid prescribing amid the worsening opioid abuse epidemic.

Nearly 70% of drug overdose deaths now involve opioid painkillers, and doctor prescribing was largely to blame for the worsening abuse rates. Many medical recommendations now call for opioids to be avoided for treating some types of pain.

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The findings of the study highlight the need for more programs focused on cancer patients, researchers concluded. They indicated cancer pain management programs should involve more than just prescribing opioid pain medications and should also include alternative treatments.

“These findings highlight the need for cancer care programs to implement evidence-based interventions to better manage cancer treatment complications, such as uncontrolled pain, in outpatient and ambulatory settings,” the researchers determined.

However, while efforts to reduce opioid prescribing and overdoses should continue, researchers say cancer patients, whom many opioids were originally designed to treat, should not face the brunt of efforts to curtail opioid use. Cancer patients often face the worse types of pain when battling late-stage cancers that, even with opioids, can hardly be managed.

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