Department of Emergency Medicine, University of Illinois Chicago, 808 S. Wood St., Chicago, IL, 60612, USA.
University of Illinois Cancer Center, Chicago, IL, USA.
J Cancer Educ. 2024 Oct;39(5):546-552. doi: 10.1007/s13187-024-02435-8. Epub 2024 Apr 15.
The purpose of this study was to examine barriers and facilitators to compliance for cancer care in patients utilizing an emergency department (ED)-based assessment. Adult ED patients who either had active cancer or a history of cancer were enrolled between August 2020 and Jan 2022 for this prospective cohort study. We piloted the National Comprehensive Cancer Network (NCCN) Distress Thermometer. Multivariable regression analyses were used to assess the predictors of high distress. Of the 152 patients enrolled, 73% were Black patients, 11% were non-Hispanic White, and 16% included patients from other racial and ethnic groups (including 10.5% Hispanic patients); 73% of the sample had active cancer. The current ED visit was cancer related for 44%. The mean score on the Distress Thermometer was 4 (SD = 2; range 0-8) with 30% having a high distress level of ≥ 6. Having an active cancer and race/ethnicity were significant predictors of high distress. Patients who had active cancer had three times (aOR = 3.01; 95% CI 1.12-8.10) higher odds of experiencing high distress in the past week compared to those who did not have active cancer, after adjusting for race/ethnicity and reason for visit. Practical problems and physical problems were the most common, with 43% (n = 66) and 40% (n = 61) of the patients reporting these problems, respectively. Despite significant progress in cancer care, cancer patients/survivors face difficulty in transitioning between care environments and end up seeking episodic care in the ED and experience a high level of distress.
本研究旨在探讨在利用急诊部（ED）评估的癌症患者中，癌症治疗依从性的障碍和促进因素。这项前瞻性队列研究于 2020 年 8 月至 2022 年 1 月期间招募了有活动性癌症或癌症病史的成年 ED 患者。我们对国家综合癌症网络（NCCN）痛苦温度计进行了试点。多变量回归分析用于评估高痛苦的预测因素。在纳入的 152 名患者中，73%为黑人患者，11%为非西班牙裔白人，16%包括其他种族和族裔群体的患者（包括 10.5%的西班牙裔患者）；73%的样本患有活动性癌症。目前的 ED 就诊与癌症有关的占 44%。痛苦温度计的平均得分为 4（SD=2；范围 0-8），有 30%的患者处于高痛苦水平（≥6）。患有活动性癌症和种族/民族是高痛苦的显著预测因素。与没有活动性癌症的患者相比，患有活动性癌症的患者在过去一周经历高痛苦的可能性高 3 倍（aOR=3.01；95%CI 1.12-8.10），在调整种族/民族和就诊原因后。实际问题和身体问题是最常见的，分别有 43%（n=66）和 40%（n=61）的患者报告了这些问题。尽管在癌症治疗方面取得了显著进展，但癌症患者/幸存者在不同治疗环境之间的过渡仍面临困难，最终在 ED 寻求偶发性治疗，并经历高度痛苦。
