2006, Number 5
<< Back Next >>
Cir Cir 2006; 74 (5)
Emergencies and urgent medical-surgical conditions attended at a comprehensive cancer center
Valdespino-Gómez VM, López-Garza JR, González-Alemán JC, Valdespino-Castillo VE
Language: Spanish
References: 24
Page: 359-368
PDF size: 84.65 Kb.
ABSTRACT
The global incidence of emergencies and urgent medical-surgical conditions in cancer patients has not been well described. The aim of the study was to identify the main symptoms and diagnoses in patients seen for consultation at the Urgent Care Service in a Mexican Comprehensive Cancer Center. This was a retrospective observational study. The information was obtained from the Continuous Admission Service daily consultation records at the Oncology Hospital, National Medical Center “21st Century”, Institute of Social Security, Mexico City. During a 6-month period, 4937 patients were seen for consultation. True oncologic emergencies were 3.7%, urgencies 52.5% and non-urgent were 43.7%. Most common symptoms for emergency and urgency patient consultations were severe pain (69.5%) and dehydration with electrolyte imbalance (11.4%). Prevalent symptoms were associated with the primary tumor or metastatic dissemination (89% cases). The most frequent baseline diseases were breast, colorectal, cervical, lung and stomach carcinomas. Defined oncologic emergencies in this series were septic shock and severe neutropenia (20%), hypovolemic shock due to severe bleeding (16.5%), and severe dyspnea due to pneumonia or pleural efusion (12%). Data evaluating the use of analgesic drug therapy for cancer pain alone indicate that 80% of patients report adequate analgesia. Analgesia failures were associated with an insufficient prescription or with inadequate consumption of opioid analgesics. The Urgent Care Center at a Comprehensive Cancer Center offers the best opportunity for diagnosis and treatment of emergencies and urgent care conditions in cancer patients.
REFERENCES
Escalante PC, Meltzer AB. Emergency care at Comprehensive Cancer Centers. In: Yeung J SC, Esclante PC, eds. Oncologic Emergencies. Hamilton, BC: Decker;2002. pp. 1-5.
2.Liu W, Ho T, Lee LE, Valdres R, Badrina N. Triage. In: Yeung J SC, Escalante PC, eds. Oncologic Emergencies. Hamilton, BC: Decker;2002. pp. 6-12.
Diaz CFA, O’Connor JM, Nervo A, et al. Non-scheduled consultation in oncologic patients. How many of them are true emergencies? An observational prostective study. Support Care Cancer 2004;12:274-277.
Markman M. Common complications and emergencies associated with cancer and its therapy. Cleveland Clin J Med 1994;61:105-114.
Lake DE, Hudis C. Oncologic emergencies: introduction. Semin Oncol 2000;27:243.
Susaki R, Fujita T, Takeda Y, et al. Oncologic emergencies associated with pancreatobiliary cancer. Nippon Geka Gakkai Zasshi 2004;105:296-300.
Biondo S, Marti-Rague. A prospective study of outcomes of emergency and elective surgeries for complicated colonic cancer. Am J Surg 2005;189:377-383.
Brigden ML. Hematologic and oncologic emergencies. Doing the most good in the least time. Postgrad Med 2001;109:143-146.
Harwood NAL, Benrubi GI, Nuss RC. Management of gynecologic oncology emergencies. Emerg Med Clin North Am 1987;5:577-599.
Sallan S. Management of acute tumor lysis syndrome. Semin Oncol 2001;28(suppl 5):3.
11.Klimo P, Schmidt MH. Surgical management of spinal metastases. The Oncologist 2004;9:188-196.
12.World Health Organization. Cancer pain relief. 2nd ed. Geneva: World Health Organization;1996.
Bruera E, Kim HN. Cancer pain. JAMA 2003;290:2476-2479.
Foley MK. Supportive care and quality of life. Management of cancer pain. In: DeVita VT, Hellman S, Rosenberg AS. Cancer. Principles & Practice of Oncology. 7th ed. Philadelphia: Lippincott Williams & Wilkins;2005. pp. 2615-2649.
15 Switzer DN, Rajagopal A. Cancer pain emergencies. In Yeung J SC, Esclante PC, eds. Oncologic Emergencies. Hamilton, BC: Decker;2002. pp. 355-368.
16.Talamo G. Pathophysiology of emergency illness due to cancer. In Yeung J SC, Esclante PC, eds. Oncologic Emergencies. Hamilton, BC: Decker; 2002. pp. 61-77.
17.Talamo G. Pathophysiology of emergency illness due to treatment of cancer. In: Yeung J SC, Esclante PC, eds. Oncologic Emergencies. Hamilton, BC: Decker;2002. pp. 78-102.
Gordon DB, Dahl JL, Miaskowki C, et al. American Pain Society recommendations for improving the quality of acute and cancer pain management. American Pain Society Quality of Care Task Force. Arch Inter Med 2005;165:1574-1580
Hagen NA, Elwood T, Ernst S. Cancer pain emergencies: a protocol for management. J Pain Symptom Manage 1997;14:45-50.
Mercadante S, Villari P, Ferrera P, Bianchi M, Casuccio A. Safety and effectiveness of intravenous morphine for episodic (breakthrough) pain using a fixed radio with the oral dialy morphine dose. J Pain Symptom Manage 2004;27:352-359.
Billings JA, Pantilat S. Survey of palliative care programas in the United States. J Palliat Med 2001;4:309.
Elsayem A, Swint K, Fisch JM, et al. Palliative care inpatient service in a Comprehensive Cancer Center: clinical and financial outcomes. J Clin Oncol 2004;22:2008-2014.
Abrahm LJ. Specialized care of the terminally ill. In DeVita VT, Hellman S, Rosenberg AS. Cancer. Principles & Practice of Oncology. 7th ed. Philadelphia: Lippincott Williams & Wilkins;2005. pp. 2702-2718.
Bruera E, Improving the care of terminally ill cancer patients and their families. J Clin Oncol 2005;23:7378-7379.