Picture this scenario: A 62-year-old widow—let’s call her “Mrs. Gand”—has recently been diagnosed with cancer. Two days after her first chemotherapy session, she’s at home resting when she is overcome with nausea. It’s 9 pm, and she can’t get her doctor on the phone. Not knowing what to do, she drives herself to the local hospital ER. After sitting in a cramped waiting room for three hours, the ER doctor admits her to the hospital, where she remains for two days.
What most people don’t know: For many cancer patients, a trip to the ER is not only unnecessary, it’s time-consuming, costly—and possibly dangerous. For one thing, ER doctors are less familiar with the side effects of cancer treatments—especially newer ones like immunotherapy, which can cause unusual symptoms such as rashes and thyroid abnormalities. A noncancer specialist may decide that it’s safer and easier to admit the patient and wait for more specialized help.
Another important reason to steer clear: After arriving, you’ll likely be stuck in a waiting room while more life-threatening cases, such as car accident victims, are seen. Hospitals are notorious sources of hospital-acquired infections. Because cancer patients usually have weaker immune systems due to chemotherapy, they are more susceptible to such infections than people who are healthy.
HOW TO AVOID THE HOSPITAL
Cancer patients have alternatives to the ER…but usually don’t know about them. To address this problem, researchers at University of Pennsylvania reviewed the medical literature to identify the best ways for cancer patients to avoid unnecessary visits to the ER and hospitalizations. The smartest strategies…
STRATEGY #1: Plan ahead. Many conditions that send cancer patients to the ER can be treated with prescription medications available at the pharmacy. With proper planning, someone like Mrs. Gand would have known that IV antinausea drugs given during chemotherapy usually wear off in 48 hours or less.
She and her oncologist could have then developed a plan to manage potential symptoms, including possibly using a prescription medication, such as ondansetron (Zofran) or prochlorperazine (Compazine), at home. Helpful: If a cancer patient can’t keep fluids down, IV fluids can sometimes be administered at the clinic where chemo is given so that an ER visit can be avoided.
What to do: Prior to chemo or any cancer treatment, ask your doctor to review any possible side effects—and what to do if any occur.
Important: White blood cell counts drop to their lowest point seven to 14 days after chemo, increasing susceptibility to infection. Knowing this ahead of time allows a cancer patient to take steps, including some of the tactics outlined in this article, to avoid a trip to a germ-laden ER during this crucial window.
Not all infections or fevers warrant hospitalization. If a cancer patient develops symptoms of an infection while at home, such as fever and/or chills, his/her oncologist may be able to see him the same day…or perhaps a colleague can squeeze him in. If you are ever unsure, you should always call your oncologist!
Exceptions: If fever, diarrhea or vomiting is accompanied by shortness of breath, racing heartbeat, stiff neck, new pain or altered mental status, call your doctor—you may have a potentially life-threatening infection known as sepsis. If your doctor is unavailable, head to the ER. When you arrive, say, “I have cancer and am concerned about infection and sepsis” to boost your odds of being seen more quickly.
STRATEGY #2: Check out local urgent care. More oncology practices and hospitals are opening urgent-care clinics specifically for cancer patients, often with same-day appointments and extended hours.
What to do: Before starting treatment, ask your oncologist about alternative places to seek care so you’re not scrambling for help should a problem arise. Ask if your oncology clinic offers same-day appointments for symptom management…or if it has an affiliated urgent-care center. Even if the oncology clinic can’t accommodate you, some practices are affiliated with specific ERs, allowing for smoother exchange of medical information.
STRATEGY #3: Stay connected. Simply relaying your symptoms to your doctor could keep you out of the ER and the hospital.
New study: Outpatient chemotherapy patients who got weekly e-mails encouraging them to report 12 common symptoms between appointments at Memorial Sloan Kettering Cancer Center in New York City fared better physically, mentally and emotionally than those who didn’t get the messages. The patients also lived five months longer, on average.
Why did the e-mails help? They encouraged patients to proactively report side effects, which promotes faster treatment…and relief.
What to do: If your oncologist’s office doesn’t offer weekly e-mail or text check-ins or other telehealth options, craft a plan with your doctor where you agree to touch base with any unpleasant symptoms, perhaps via a secure online portal. You can also ask if there’s a nurse available for such check-ins.
STRATEGY #4: Ask about palliative care. Early palliative care, which focuses on relief from the symptoms and stress of a serious illness, enhances quality and duration of life for patients with chronic or end-stage cancer. Meeting with a palliative care physician early on—soon after diagnosis, ideally—can help ease pain, depression and more.
These specialists are usually covered by insurance and collaborate with you and your oncologist to keep you comfortable and out of the ER. A specialist isn’t always necessary, though—most oncologists have some training in palliative care, too.
Important: Palliative care is not hospice. Hospice focuses on a person’s final six months, when curative treatment is no longer possible. Palliative care can help nonterminal patients and is used in conjunction with treatment.