• Imad El Majzoub, Aiham Qdaisat, Patrick S Chaftari, Yeung Sai-Ching J SJ Department of Emergency Medicine, Unit 1468, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, USA., Rasha D Sawaya, Mazen Jizzini, Carreras Maria Teresa Cruz MTC Department of Emergency Medicine, Unit 1468, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, USA., Hussna Abunafeesa, and Ahmed F Elsayem.
• Department of Emergency Medicine, Unit 1468, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, USA.
• Support Care Cancer. 2019 Jul 1; 27 (7): 2649-2655.

PurposeConsultation to palliative care (PC) services in hospitalized patients is frequently late after admission to a hospital. The purpose of this study is to examine the association of in-hospital mortality and timing of palliative care consultation in cancer patients admitted through the emergency department (ED) of MD Anderson Cancer Center.MethodsInstitutional databases were queried for unique medical admissions over a period of 1 year. Primary cancer type, ED versus direct admission, length of stay (LOS), presenting symptoms, and in-hospital mortality were reviewed; patient data were analyzed, and risk factors for in-hospital mortality were identified. The association of early palliative care consultation (within 3 days of admission) with these outcomes was studied. Descriptive statistics and multivariate logistic regression model were used.ResultsEqual numbers of patients were admitted directly versus through the ED (7598 and 7538 respectively). However, of all patients who died in the hospital, 990 (88%) were admitted through the ED, compared with 137 admitted directly (P < 0.001). Patients who died in the hospital had longer median LOS compared with patients who were discharged alive (11 vs. 4 days, respectively, P < 0.001). Early palliative care consultation was associated with decreased mortality, compared with late consultation (P < 0.001). Chief complaints of respiratory problems, neurologic issues, or fatigue/weakness were significantly associated with in-hospital mortality.ConclusionWe found an association between ED admission and hospital mortality. Decedent cancer patients had a prolonged LOS, and early palliative care consultation for terminally ill symptomatic patients may prevent in-hospital mortality and improve quality of cancer care.

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