Cancer pain management in the emergency department: a multicenter prospective observational trial of the Comprehensive Oncologic Emergencies Research Network (CONCERN)

Christopher J. Coyne, Cielito C. Reyes-Gibby, Danielle D. Durham, Beau Abar, David Adler, Aveh Bastani, Steven L. Bernstein, Christopher W. Baugh, Jason J. Bischof, Corita R. Grudzen, Daniel J. Henning, Matthew F. Hudson, Adam Klotz, Gary H. Lyman, Troy E. Madsen, Daniel J. Pallin, Juan Felipe Rico, Richard J. Ryan, Nathan I. Shapiro, Robert SworCharles R. Thomas, Arvind Venkat, Jason Wilson, Sai Ching Jim Yeung, Jeffrey M. Caterino

    Research output: Contribution to journalArticlepeer-review

    Abstract

    Purpose: Many patients with cancer seek care for pain in the emergency department (ED). Prospective research on cancer pain in this setting has historically been insufficient. We conducted this study to describe the reported pain among cancer patients presenting to the ED, how pain is managed, and how pain may be associated with clinical outcomes. Methods: We conducted a multicenter cohort study on adult patients with active cancer presenting to 18 EDs in the USA. We reported pain scores, response to medication, and analgesic utilization. We estimated the associations between pain severity, medication utilization, and the following outcomes: 30-day mortality, 30-day hospital readmission, and ED disposition. Results: The study population included 1075 participants. Those who received an opioid in the ED were more likely to be admitted to the hospital and were more likely to be readmitted within 30 days (OR 1.4 (95% CI: 1.11, 1.88) and OR 1.56 (95% CI: 1.17, 2.07)), respectively. Severe pain at ED presentation was associated with increased 30-day mortality (OR 2.30, 95% CI: 1.05, 5.02), though this risk was attenuated when adjusting for clinical factors (most notably functional status). Conclusions: Patients with severe pain had a higher risk of mortality, which was attenuated when correcting for clinical characteristics. Those patients who required opioid analgesics in the ED were more likely to require admission and were more at risk of 30-day hospital readmission. Future efforts should focus on these at-risk groups, who may benefit from additional services including palliative care, hospice, or home-health services.

    Original languageEnglish (US)
    Pages (from-to)4543-4553
    Number of pages11
    JournalSupportive Care in Cancer
    Volume29
    Issue number8
    DOIs
    StatePublished - Aug 2021

    Keywords

    • Acute care
    • ED
    • Emergency department
    • Pain management
    • Palliative care

    ASJC Scopus subject areas

    • Oncology

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