Background Is chemotherapy or the disease the cause for attendance at the emergency service?

Purpose The aim was to describe the characteristics of oncologic patients attending the emergency room of a regional hospital and study the relationship between the reason for admission and possible chemotherapy related adverse events.

Material and methods Observational and retrospective study of oncologic patients attending the emergency room during the period January to December 2015. Data were collected from digital medical records. The following variables were analysed: tumour location; tumour stage; chemotherapy (yes/no); antineoplastic agents involved; reason for admission and discharge diagnosis; and resolution of the episode (income, discharge).

The data were processed using SPSS.v.10

Results 118 visits of oncologic patients were analysed. 61.9% were men and mean age was 64.24 years. 20.3% were of colorectal origin; 17.8% pulmonary; and 22.8% digestive tumours. In 66% of cases patients had stage IV disease, followed by 26% with stage III. 90.7% were being treated with chemotherapy. The most common antineoplastic was capecitabine (24 cases), followed by carboplatin (21 cases) and cisplatin (15 cases). The highlight for new antineoplastic agents were 2 cases with nivolumab whose reasons for admission were dysphagia and dyspnoea, respectively; 2 cases with pazopanib because of fever and pain, respectively; and 3 cases with sunitinib, whose reasons for admission were vomiting in two cases and anaemia in one case. The most frequent reason for admission was dyspnoea (30.5%), followed by fever (24.6%), vomiting(7.6%) and diarrhoea(5.9%). The most frequent discharge diagnoses were pneumonia (13.6%), febrile syndrome (8.5%), ITU (6.8%), febrile neutropenia (5.9%), disease progression (5.9%), pulmonary thromboembolism (5.9%) and diarrhoea (5.9%), among others. 41.5% of patients required admission to internal medicine and 17 (34.7%) died.

Conclusion Capecitabine and platinum based drugs were the most common cytostatics in these oncologic patients who attended the emergency room. The new oral antineoplastics present new adverse events and many interactions with others drugs. Reasons for admission described in this study were the usual adverse effects of cytostatic drugs. The emergency pharmacist, along with the emergency physician team, must implement clinical guidelines to manage common adverse events of antineoplastic drugs and identify those drugs interactions that may be causing the adverse events.

No conflict of interest