A study of the factors associated with emergency department visits in advanced cancer patients receiving palliative care

Purpose: Several studies demonstrated that cancer patients visited the emergency department (ED) frequently. This indicates unmet needs and poor-quality palliative care. We aimed to determine the factors that contribute to ED visits in this population. Methods: : A retrospective study was conducted between January and December, 2019. The trial ended when the patients died, were referred to other palliative programs, or the study ended date. All patients age > 18 years old were included. Patients were excluded if they died before discharge, were referred to other programs, or had an incomplete record. The Poisson regression analysis was done to investigate the factors associated with ED visits. The multiple logistic regression included variables with a P value < 0.15 from the univariate analysis. Results: : Among a total of 227 patients, 93 visited the ED and 134 did not. Mean age was 65.5 years. Most prevalent cancers were colorectal(18.5%), lung(16.3%), and hepatobiliary(11.9%). At the end, 146 patients died, 45 were alive, nine were referred to other programs, and 27 were lost to follow-up. In univariate analysis, patients with >100 days from palliative consultation (IRR 0.3; 95%CI0.11, 0.80; p-value 0.02) were less likely to attend the ED. PPS 50-90% (IRR 1.56;95%CI 1.02,2.39; p-value 0.03) increased the ED visits. In the multivariate analysis, those two factors remained associated with ED visits:>100 days from the palliative consultation (IRR 0.27; 95%CI0.10, 0.73; p-value 0.01) and PPS 50-90% (IRR 1.76; 95%CI1.14, 2.72; p-value 0.01). Conclusions: : Involving palliative three months before death in cancer patients may reduce ED visits.