الفهرس 
The aim of the studyOnly 14 pages are availabe for public view
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Abstract
An oncological emergency is an acute condition that is caused by cancer or its treatment, requiring rapid intervention to avoid death or severe permanent damage. Identification and treatment of these conditions is of vital importance to medical practitioners especially in areas where inpatient oncological services are lacking. Most of these problems can be successfully treated if one has a high index of suspicion.
With the increasing incidence of cancer in the general population, combined with improved survival and widespread use of cancer therapeutic agents relying on the outpatient treatments, emergency department (ED) physicians are increasingly encountering patients who present with symptoms related to underlying cancer and diverse toxicities that are direct effects of its treatments.
The current practice of treating and managing cancer in ED needs:
(2) Understanding the clinical needs of patients with cancer in the ED.
(3) Developing cancer specific evidence-based ED interventions.
(4) Improving the quality of cancer are delivery in the ED.
(5) Implementing efforts to reduce emergency care use the oncology setting.
Initial steps in filling this knowledge are to identify the characteristics and clinical presentation of patients with cancer visiting the ED and factors related to subsequent inpatient admission and mortality.
The core of the management in ED is a systematic approach based on the ABCDE survey to assess and treat the oncologic emergency. The goal is to identify and manage any immediate threat to life and to identify any potential threats.
The results of this study are an eye-opener to what can be done for cancer patients arriving to ED with different emergencies.
The study included 300 cancer patients underwent initial assessment and management guided by advanced life support guidelines in emergency department, Menoufiya University Hospitals.
Their median age was 58 years (range 20-87). There were 156 (52%) females and 144 (48%) males. there are 51 patients with repeated visits to our emergency department arranged in double and triple visits. Time of first diagnosis (less than or equal a year) found in 220 patients (73.3%).
Tumours according to the involved system are presented in 9 groups. Among them the most common were the genitourinary system in 71 (23.7%) patients, the gastrointestinal system in 65 (21.7%) and hematological malignancies in 52 (17.3%). The commonest primary cancer organs were breast in 47 (15.7%) patients, urinary bladder in 35 (11.7%), and lymphoma in 30 (10%). We found cancer metastasis in 127 (42.3%) patients and cancer without metastasis in 173 (57.7%).
Chemotherapy was the active cancer treatment in 221 (71%.3) patients then radiotherapy in 29 (9.6%). In the follow-up (previous) cancer treatment we found 209 (69.7%) patients on single treatment and 91 (30.3%) on combined (chemotherapy, radiotherapy, hormonal or surgical) treatment.
The commonest triage complaints are the shortness of breath found in 58 (19.3%) patients, decrease conscious level in 48 (16%) and fever in 45 (15%). Due to their variety, we arranged them in 8 groups as:
1- Neurological complaints (decrease conscious level, upper & lower limbs weakness, lower limbs weakness alone, fits and facial weakness) were in 69 (23%) patients,
2- Shortness of breath was in 58 (19.3%),
Summary
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3- Gastrointestinal complaints (abdominal pain, vomiting, diarrhea and jaundice) were in 53 (17.7%),
4- Fever was in 45 (15%),
5- Others include dizziness, anorexia, facial edema and lower limbs pain which presented 41 (13.7%),
6- Bleeding (bleeding per rectum, hematemesis, melena and hematuria) was in 19 (6.3%),
7- Cardiological complaints (chest pain and syncope) were in 8 (2.7%),
8- Genitourinary complaints (anuria and oliguria) were in 7 (2.3%).
According to the distribution of triage priorities, the commonest for patients triaged to the Resuscitation Room (Priority 1) by 145 (48.3%) patients. 214 (71.3%) had advanced resuscitation while 86 (28.7%) patients had basic (supportive care) resuscitation.
Treatments judged to be important ones for current illness were collected, and some patients received more than one treatment. Parenteral antibiotics administration (27.7 %) and central line insertion (18.7 %) were the most common treatments. specific treatment such as GIT endoscopy, urgent dialysis (17.3 %) while drainage procedures (10.3%).
Disease progression found in 123 (41%) patients, infection was in 102 (34%), cancer treatment related complications were in 66 (22%) and non-cancer related problems were in 9 (3%).
There is highly significant relation between PACS triage priority and complaint, critical interventions, diagnosis & outcome so, PACS system may be a useful model for triaging patients with cancer in ED and sorting their prioritizations of the initial assessment and management and a risk stratification tool in of ED outcome among cancer patients.
Active cancer treatment can affect ER diagnosis and outcome as there is a high significant relation with outcome and a significant one with diagnosis.
Cancer type could affect complaint, diagnosis and outcome. GIT malignancies were more likely to result in a hospital admission (ICU and ward). Of the 54 patients with GIT malignancies who were admitted to the hospital, 27 (21.7%) were admitted to the ICU. Among the various cancer types, the highest ER mortality rates were seen for genitourinary malignancies by 41.6%.
Factors that affect ED outcome are cancer type, active cancer treatments, triage complaint, triage priority and diagnosis as Outcome showed highly statistically significant value among diagnosis categories, resuscitation and triage priority.
Factors that affect hospital outcome are increased age, active cancer treatment, triage complaint, triage category, diagnosis and MASCC score.
Our study showed that older age, palliative treatment, secondary metastasis, neurologic complaints, priority 1 triage category and disease progression may be predictors for poor ED outcome among cancer patients.