Triple threat of mortality among advance cancer patients presenting to an emergency department.

Abstract

138 Background: Early identification of cancer patients with short survival will help address end of life issues and avoid costly interventions. Dyspnea, delirium, and poor performance are known to predict short survival in palliative care. Our goal is to test whether these 3 conditions could predict mortality in the emergency department (ED) setting because a shorter tool would be practical. Methods: We randomly selected 243 English-speaking patients with advanced cancer who presented to the MD Anderson hospital ED and who were judged clinically stable. Patients were assessed for the presence of delirium (Confusion Assessment Method and Memorial Delirium Assessment Scale), poor performance (Eastern Cooperative Oncology Group score 3 or 4), and dyspnea (MD Anderson Symptom Inventory shortness of breath score > 5). All measures (survival and symptom) were available for 212 patients. Triple threat was defined as the presence of one of more of the 3 conditions: delirium (by either tool), poor performance, or dyspnea. We obtained survival data from medical records. Results: The table below shows each condition frequency, predicted probability of 30-day survival, and median OS. In pairwise comparisons adjusting for multiple comparisons, participants with 2 or more of the symptoms had poorer 30-day survival and OS. Conclusions: Patients with advanced cancer who have at least two of the triple threat conditions should have early discussion of goals of care to avoid costly and aggressive interventions. Further research including clinically unstable patients should be performed. [Table: see text]