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Emergency Care for Cancer Patients
Reasons for emergency room visits

Many cancer patients need some type of emergency care during the course of their illness and treatment. Neutropenic fever is one of the most common reasons, but there are a number of others as well. Oncologic emergencies are usually either compressive or obstructive, metabolic, or cytopenic in nature.

Obstructive or compressive complications can arise when tumors—either primary or metastatic—impinge on nearby organs or structures. Brain tumors or metastases can cause seizures, headaches, strokes, and a host of neurologic symptoms, for example. Spinal cord compression, deep vein thrombosis and pulmonary emboli, superior vena cava syndrome, and obstructed ureters, vessels, airways, and ducts are other examples of compressive or obstructive conditions. Some of these conditions—pleural and pericardial effusions and cardiac tamponade, for example—can result either from the cancer itself or from treatment effects, notably radiation.
Metabolic emergencies like hyperuricemia and hypercalcemia can arise when tumors secrete hormone-like peptides that can disrupt electrolyte balances. Tumor lysis syndrome is a metabolic crisis caused by the destruction of cancer cells. As neoplastic cells die in response to therapy, their intracellular contents are spilled into circulation, causing hyperuricemia and potentially severe disturbances in all of the major electrolytes.
Cytopenic crises in cancer patients who present for emergency care include thrombocytopenic bleeding, neutropenic fever, and acute autoimmune hemolytic anemia. Of these, neutropenic fever is the most common and is usually related to the immunosuppressive effects of chemotherapy, which render patients highly susceptible to potentially dangerous infections.
About 19,000 patients were treated in M. D. Anderson Cancer Center’s Emergency Center (EC) last year. Most were M. D. Anderson patients. About 86% of them presented with urgent or emergent conditions. Not all conditions were directly related to cancer; the focus of this facility is not limited to “oncologic emergencies” but rather to any urgent care needs of cancer patients.

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Original Post
When Problems Can't Wait: the Emergency Room and Cancer

June 3, 2009, by Bayan Raji
Complications of cancer and cancer treatment don't always have regard for doctor's office hours. Problems may arise any time of the day or night, and a medical emergency comes on suddenly.

For instance, under normal circumstances a fever might be a typical sign of illness and nothing to be alarmed about. However, for cancer patients with compromised immune systems, a fever of 101 degrees Fahrenheit or above signals it's time to call the ambulance or visit the emergency room.

Don't hesitate to seek care

While the answers are not always clear cut, patients and caregivers should familiarize themselves with the side effects of medication and treatment so they have a better idea of what might occur, says Carmen Gonzalez, M.D., associate professor and chief of the Section of Emergency Care (EC) at M. D. Anderson.

It's always best to visit the EC if there are any doubts, she says. Early treatment may help prevent symptoms from becoming worse.

"You should always come in sooner than later," she says. "If you come in sooner, your condition may be easier to treat. In addition, early treatment may help you improve faster so you will not have to spend as much time in the hospital, and you could prevent complications."

Know when to make the call

If you are being treated for cancer, your physician probably will give you information about possible side effects and when to seek emergency care. If you do not receive information, ask your doctor about potential problems.

If problems occur during the day, you can contact your doctor's office. But after hours, you may need to visit the EC.

As a general rule, Gonzales says a medical emergency is defined as a sudden unexpected occurrence of circumstances like changes in physical or mental status, or a new symptom, such as severe pain, that affects a person's well-being and demands immediate action.

If you experience chemotherapy- or radiation-induced side effects, for example, nausea, vomiting or diarrhea, and you are unable to control them with medications prescribed by your doctor, you should seek medical care in the EC.

The most common problems for which cancer patients come to the EC are pain or high fever. Other common complaints include:

  • Nausea/vomiting
  • Severe diarrhea
  • Bleeding
  • Shortness of breath
  • Extreme weakness or weakness affecting a part of the body
  • Headache
  • Confusion or change in behavior
  • Rash or skin discoloration
  • Swollen leg or arm
  • Injury or trauma

Caregivers should be involved

In an emergency, a caregiver may have to act on a patient's behalf. It is important for caregivers to be aware of the possible side effects of treatment so they will know what to expect. They also should keep contact numbers for the physician and hospital handy.

"Knowing the symptoms and potential complications will put caregivers a step ahead if the patient develops a problem," Gonzalez says.

Cancer hospital may not be right choice

Should you experience a major trauma or injury, such as a car accident or a serious fall, you should be treated at a city's trauma emergency center. Most cancer centers aren't equipped to handle injuries of this type.

If you are injured or become ill away from the city where you are being treated for cancer, go to the local ER in case of an emergency. The staff will call your cancer physician if they have questions or you need to be transferred.

Be sure to follow up with your cancer physician after an EC visit. The EC staff should give you clear instructions about when to contact your doctor, Gonzalez says.

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