Oncologic Emergency Research Articles

Construction and validation of the Emergency Oncology Scale (EMOnco), a risk rating protocol for the triage of cancer patients in acute care settings.

Manfredini et al. demonstrate that the new rating protocol, EMOnco, can triage of cancer patients in acute care settings safely, considering their cancer type, stage and treatment histories and oncological emergencies, enabling the appropriate classification from high-risk patients to non-urgent patients. ■ EMOnco considers variables related to the cancer history and treatment. ■ Triages patients in the emergency care in less than three minutes. ■ Cancer patients need priority care regarding infection, and this protocol consider it. ■ EMOnco has shown to be a valid and reliable scale for the triage of oncological patients in the emergency room or acute care clinics. To validate a risk rating scale for triaging of cancer patients in emergency rooms that can identify individuals needing urgent care or in imminent worsening of the clinical condition. This is a health instrument validation study developed in the emergency care ward of a Brazilian hospital, a referral center for cancer and hematological diseases. We built the Emergency Oncology Scale (EMOnco) based on literature review and a Delphi survey with 20 experienced oncologists (physicians and nurses). We validated the scale by assessing its construct validity, interobserver agreement and reliability after applying them in a convenience sample of all consecutive patients with cancer who visited the ward between August 2017 and January 2018. We compared the EMOnco Scores with those from other scales, used by six trained nurses: the Emergency Severity Index, the Manchester Triage System, and the Karnofsky Performance Status. We also recorded socio-demographic and clinical features and the Sequential Organ Failure Assessment (SOFA) results in the intensive care unit. We included 250 patients with locally advanced or recurrent disease and undergoing chemotherapy. EMOnco screening took 2.24 (± 2.9) minutes in average. The interobserver correlation coefficient was 0.9. EMOnco was highly correlated with Emergency Severity Index (r=0.617) and also correlated with Karnofsky Performance Status (0.420) Manchester Triage System (0.491; p<0.001 for all). EMOnco in Portuguese considers variables related to the cancer history and treatment and has proven to be a valid and reliable for the risk classification of oncological patients in emergency care services.

Integrating diabetes care into an oncology practice: A patient-centric model of care delivery at a safety-net health system.

2 Background: Oncologic treatments can disrupt glycemic control in people with diabetes and induce dysglycemia in individuals without diabetes through the use of steroids and/or targeted therapies. Severe hyperglycemia can result in delay/interruption of oncologic care and emergency department (ED) utilization. Here we report on an integrated model of diabetes care at a safety-net system, where patients commonly use the ED for their care. Methods: Parkland Health is an academic-affiliated safety-net system, primarily providing care for the un-/under-insured patients in Dallas County. An advanced nurse practitioner specializing in diabetes care (DM-ANP), supervised by an endocrinologist, was embedded in oncology clinics. Patients were referred to the DM-ANP by their oncology provider, or through an automated process if they had a recent hemoglobin A1c &gt;8.0% or a random blood sugar &gt; 250mg/dL. Patient education was provided by a trained nurse educator. Nutrition consult was available through an oncology dietitian. An acute hyperglycemia management protocol was developed to manage patients in the infusion center and prevent unnecessary ED visits. Results: Between March 2021 and March of 2024, the DM-ANP provided 4,276 visits to 797 distinct patients (average, 1425 visits per year). Breast cancer was the most common malignancy among patients seen in the integrated clinic. DM-ANP visits were coupled with oncology visits (clinic or infusion) or via telehealth, thereby increasing access and decreasing number of days patients had to come to clinic to receive care. Telehealth visit rate was highest in 2021 (27.5%) reflecting the impact of the pandemic, and subsequently dropped to 10.1% in 2023. Patients who were seen by the DM-ANP had an overall lower number of ED visits. Comparing prior vs post establishing care with the DM-ANP, the total number of ED visits by patients with diabetes significantly reduced in 2021-2022 (2021: 970 vs. 241, p &lt;0.01; 2022: 796 vs. 501, p&lt;0.01) before equilibrating in 2023-2024; (2023: 426 vs. 468, p=0.24). On average, patients had 1.2 less ED visits after receiving care from the DM-ANP. Since in-person visits were coupled with other oncology visits, the no-show rate for DM-ANP mirrored the rates for oncology clinics/infusion visits. Conclusions: Integrating diabetes/glycemic management into our oncology practice provided a patient-centric model of care delivery, improved visit adherence compared to an off-site model, reduced the time-toxicity by having fewer clinic visit days. Future directions include comparing oncologic outcomes in patients who had DM-ANP management to those who were managed by primary care.

Comparison of postoperative prognoses for resectable colorectal cancer with vs. without oncologic emergency using propensity score‑matched analyses: A single-center retrospective observational study.

While oncological emergencies in colorectal cancer present distinct challenges, existing literature offers conflicting evidence regarding long-term outcomes. Therefore, the present study compared the postoperative prognoses between patients with and without oncological emergencies. A retrospective evaluation was conducted on patients who had undergone radical surgery for pathological stages II and III colorectal cancer at a single center between January 2012 and December 2020. Patients were classified into the non-emergency and oncological emergency groups. The status of oncologic emergency was divided into obstruction and perforation. The outcomes were compared using propensity score matching. The primary objective was to compare the postoperative prognoses between non-emergency and oncological emergency situations. The secondary objectives included comparing prognoses between obstruction and perforation, identifying the type of recurrence depending on the status of oncologic emergency, and assessing the effect of adjuvant chemotherapy for oncologic emergencies. This study included 524 patients. After propensity score matching, the prognoses of oncological emergencies were worse compared with those without any emergency, whereas those of obstruction and perforation did not significantly differ. Regarding the type of recurrence, peritoneal dissemination in obstruction and local recurrence in perforation was more common compared with that in non-emergency cases. Adjuvant chemotherapy improved the recurrence-free survival for cases with oncological emergencies. The prognoses in cases with oncological emergencies could be worse compared with those without any emergency, whereas obstruction and perforation outcomes can be comparable. The administration of adjuvant chemotherapy should be strongly considered for oncological emergencies.

Advances in Imaging for Metastatic Epidural Spinal Cord Compression: A Comprehensive Review of Detection, Diagnosis, and Treatment Planning.

Metastatic epidural spinal cord compression (MESCC) is a critical oncologic emergency caused by the invasion of metastatic tumors into the spinal epidural space, leading to compression of the spinal cord. If not promptly diagnosed and treated, MESCC can result in irreversible neurological deficits, including paralysis, significantly impacting the patient's quality of life. Early detection and timely intervention are crucial to prevent permanent damage. Imaging modalities play a pivotal role in the diagnosis, assessment of disease extent, and treatment planning for MESCC. Magnetic resonance imaging (MRI) is the current gold standard due to its superior ability to visualize the spinal cord, epidural space, and metastatic lesions. However, recent advances in imaging technologies have enhanced the detection and management of MESCC. Innovations such as functional MRI, diffusion-weighted imaging (DWI), and hybrid techniques like positron emission tomography-computed tomography (PET-CT) and PET-MRI have improved the accuracy of diagnosis, particularly in detecting early metastatic changes and guiding therapeutic interventions. This review provides a comprehensive analysis of the evolution of imaging techniques for MESCC, focusing on their roles in detection, diagnosis, and treatment planning. It also discusses the impact of these advances on clinical outcomes and future research directions in imaging modalities for MESCC. Understanding these advancements is critical for optimizing the management of MESCC and improving patient prognosis.

Tumour lysis syndrome.

Tumour lysis syndrome (TLS) represents a critical oncological emergency characterized by extensive tumour cell breakdown, leading to the swift release of intracellular contents into the systemic circulation, outpacing homeostatic mechanisms. This process results in hyperuricaemia (a by-product of intracellular DNA release), hyperkalaemia, hyperphosphataemia, hypocalcaemia and the accumulation of xanthine. These electrolyte and metabolic imbalances pose a significant risk of acute kidney injury, cardiac arrhythmias, seizures, multiorgan failure and, rarely, death. While TLS can occur spontaneously, it usually arises shortly after the initiation of effective treatment, particularly in patients with a large cancer cell mass (defined as ≥500 g or ≥300 g/m2 of body surface area in children). To prevent TLS, close monitoring and hydration to improve renal perfusion and urine output and to minimize uric acid or calcium phosphate precipitation in renal tubules are essential. Intervention is based on the risk of a patient of having TLS and can include rasburicase and allopurinol. Xanthine, typically enzymatically converted to uric acid, can accumulate when xanthine oxidases, such as allopurinol, are administered during TLS management. Whether measurement of xanthine is clinically useful to optimize the use of allopurinol or rasburicase remains to be determined.

Patients with TP53-Mutated Acute Myeloid Leukemia Receiving Intensive Induction Therapy Have Superior Outcomes Due to a Higher Rate of Salvage Therapy: A Single Institution, Retrospective Study.

TP53 mutations (TP53m) define the most treatment-refractory acute myeloid leukemia (AML) subtype. Optimal treatment approaches have not been established in this setting. We reviewed our institutional experience to identify therapy sequencing, treatment response, and survival patterns in these patients. This study was a single-center, retrospective cohort analysis. Our cohort includes 86 TP53m and 337 TP53 wild-type (TP53wt) adult AML patients. TP53m AML patients presented with lower bone marrow and peripheral blasts; none presented with hyperleukocytosis. Patients who received intensive treatment up front demonstrated superior overall survival (OS) over those receiving first-line non-intensive therapy (2-year OS 22% versus 7%; p = 0.02). However, the complete remission (CR) rates among the first-line intensive and non-intensive therapy groups were comparable (21.9% and 29.4%, respectively, p = 0.49). The improved OS is therefore attributed to superior cumulative CR in the intensive group. First-line intensively treated patients were more likely to receive and respond to salvage, leading to a cumulative CR rate of 65.7% (versus 29.4%, p = 0.003). Achieving CR at any point is strongly associated with superior survival outcomes with 2-year OS of 31% versus 0% for those not achieving CR ever (p < 0.01). We find that TP53m AML rarely presents with oncological emergencies, suggesting that clinical trial enrollment is feasible in this group. Additionally, in our cohort, intensive induction therapies lead to superior survival outcomes attributed to successful salvage therapy. These data suggest that strategic therapy sequencing and salvage therapy may be important in optimizing outcomes for TP53m AML patients.

Cross-Sectional Study of Thiamine Deficiency and Its Associated Risks in Emergency Care.

Growing data indicates that thiamine deficiency occurs during acute illness in the absence of alcohol use disorder. Our primary objective was to measure clinical factors associated with thiamine deficiency in patients with sepsis, diabetic ketoacidosis, and oncologic emergencies. This was an analysis of pooled data from cross-sectional studies that enrolled adult emergency department (ED) patients at a single academic center with suspected sepsis, diabetic ketoacidosis, and oncologic emergencies. We excluded patients who had known alcohol use disorder or who had received ED thiamine treatment prior to enrollment. Investigators collected whole blood thiamine levels in addition to demographics, clinical characteristics, and available biomarkers. We defined thiamine deficiency as a whole blood thiamine level below the normal reference range and modeled the adjusted association between this outcome and age. There were 269 patients, of whom the average age was 57years; 46% were female, and 80% were Black. Fifty-five (20.5%) patients had thiamine deficiency. In univariate analysis, age >60years (odds ratio [OR] 2.5, 95% confidence interval [CI], 1.3-4.5), female gender (OR 1.9, 95% CI 1.0-3.4), leukopenia (OR 4.9, 95% CI 2.3-10.3), moderate anemia (OR 2.8, 95% CI 1.5-5.3), and hypoalbuminemia (OR 2.2, 95% CI 1.2-4.1) were associated with thiamine deficiency. In adjusted analysis, thiamine deficiency was significantly higher in females (OR 2.1, 95% CI 1.1-4.1), patients >60years (OR 2.0, 95% CI 1.0-3.8), and patients with leukopenia (OR 5.1, 95% CI 2.3-11.3). In this analysis, thiamine deficiency was common and was associated with advanced age, female gender, and leukopenia.

Empathy Unmasked: Patient Perception of Physician Empathy in an Oncologic Emergency Setting. A Randomized Controlled Trial Comparing Personal Protective Equipment Wear versus Unmasked Video Communication

BackgroundAmidst the COVID-19 pandemic, telemedicine emerged as an important option that supports and facilitates clinical practice, however, its usefulness in emergency settings that treat patients with cancer is unclear. ObjectiveTo evaluate patient perception of physician empathy in an emergency oncology setting, comparing video interaction to an in-person with personal protective equipment (PPE) approach. MethodsIn this single-center, prospective, cross-sectional, survey-based randomized controlled trial, patients were randomized 1:1 for the concluding conversation done in-person which included either interacting with physicians wearing PPE or video interaction with physicians without PPE (virtual). Patients’ perceptions of the physicians’ relational empathy were assessed and compared for each group by using the Consultation and Relational Empathy (CARE) Measure and the Perception of Physician Compassion measure. ResultsPatients (n=106) in both the PPE and virtual arms provided favorable responses to all questions. The mean overall CARE scores for the PPE and virtual arms were 45.02 and 44.43, respectively (difference, 0.58 [95% CI: -2.10, 3.30]). Regarding the linear physician compassion scores, patients in the virtual arm appeared to consider physicians to be warmer (difference, -0.42 [95% CI: -0.87, 0.04]) but less pleasant (difference, 0.33 [95% CI: -0.40, 1.10]) than did patients in the PPE arm. ConclusionsCancer patients presenting to the emergency department perceive empathy and compassion equally when approached by physicians virtually without PPE or in person while wearing PPE. Virtual services for specific aspects of clinical practice during emergency department visits in an oncology setting can be implemented to ensure safer interactions between patients and physicians without compromising the physician-patient relationship.

Designing and evaluating ONCologic EMergencies escape room game for undergraduate nursing students: The ONCEM quasi-experimental pilot study

Designing and evaluating ONCologic EMergencies escape room game for undergraduate nursing students: The ONCEM quasi-experimental pilot study

Review of Leukemia in Children

Leukemia is the most common cancer in children, accounting for approximately one-third of all pediatric cancers. This disease affects the blood-forming tissues, with leukemic cells first growing in the bone marrow, then entering the peripheral blood, and possibly spreading to various organs, including the skin. Acute leukemia’s clinical symptoms stem from the frequently rapid onset of bone marrow failure. The clinical presentation typically includes high fever, gastrointestinal and pulmonary symptoms, severe and worsening anorexia, muscle and joint pain, and bleeding. This review explores the incidence and general epidemiology of childhood leukemia, including risk-increasing syndromes; recognizes the clinical presentation and interpretation of blood counts; examines potential oncologic emergencies; describes prognostic factors and the importance of minimal residual disease in precursor B-lymphoblastic leukemia; highlights supportive care in treating acute myelogenous leukemia; and addresses long-term complications of modern childhood leukemia treatments. This narrative review discusses the evidence suggesting an in-utero origin of childhood acute leukemia, focusing on acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML). It highlights the significant diagnostic presence of these acute leukemias among hematologic cancers, the investigations into prenatal leukemogenesis, and the literature on prenatal risk factors during gestation.

Review of Leukemia in Children

Leukemia is the most common cancer in children, accounting for approximately one-third of all pediatric cancers. This disease affects the blood-forming tissues, with leukemic cells first growing in the bone marrow, then entering the peripheral blood, and possibly spreading to various organs, including the skin. Acute leukemia’s clinical symptoms stem from the frequently rapid onset of bone marrow failure. The clinical presentation typically includes high fever, gastrointestinal and pulmonary symptoms, severe and worsening anorexia, muscle and joint pain, and bleeding. This review explores the incidence and general epidemiology of childhood leukemia, including risk-increasing syndromes; recognizes the clinical presentation and interpretation of blood counts; examines potential oncologic emergencies; describes prognostic factors and the importance of minimal residual disease in precursor B-lymphoblastic leukemia; highlights supportive care in treating acute myelogenous leukemia; and addresses long-term complications of modern childhood leukemia treatments. This narrative review discusses the evidence suggesting an in-utero origin of childhood acute leukemia, focusing on acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML). It highlights the significant diagnostic presence of these acute leukemias among hematologic cancers, the investigations into prenatal leukemogenesis, and the literature on prenatal risk factors during gestation.

Evaluation and management of febrile neutropenia in patients with cancer.

Febrile neutropenia is a common oncologic emergency that increases the risk for serious infection. This article reviews a joint American Society of Clinical Oncology and Infectious Diseases Society of America guideline for the evaluation and management of patients with cancer who present with fever and neutropenia. Knowledge and use of available risk assessment tools may reduce unnecessary hospitalizations, decrease inappropriate antibiotic use, and improve patient outcomes.

Palliating hematologic oncologic emergencies with radiation in the age of targeted systemic therapies: three illustrative cases.

Hematologic oncologic emergencies with an urgent indication for radiation are a relatively routine occurrence for the radiation oncologist. As patients are living longer and have multiple treatment options for their relapsed or refractory diseases, it is important that palliative treatments avoid precluding patients from or delaying next-line potentially curative treatments wherever possible. We highlight the following experiences from our clinical practice: newly diagnosed plasma cell disease causing cord compression; life threatening cutaneous lymphoma with tumors covering the majority of the body surface area; and relapsed/refractory diffuse large B-cell lymphoma (DLBCL) requiring bridging radiation to a mass impinging on the brachial plexus combined with chimeric antigen receptor (CAR)-T cell therapy. In each case, urgent palliative radiation was utilized, but the approaches were nuanced, with careful consideration of subsequent potential therapies and how the current course of radiation should be tailored for the best interplay with the overall treatment course and trajectory of the disease. With the rapid development of new therapies, it can be difficult to stay up to date on the most recent practice guidelines. Drawing on hematologic-specific guidelines, such as those provided by the International Lymphoma Radiation Oncology Group, and disease site experts can aid in ensuring patients are appropriately palliated and eligible for future therapies.

Essential Review of Oncological Emergencies

Innovations in oncology have expanded treatment eligibility, leading to a rise in cancer patients requiring critical care. This necessitates that all critical care clinicians possess a fundamental knowledge of prevalent oncological conditions and identify emergent scenarios requiring immediate action. This article will explore key oncological complications and their management approaches.

A study to quantify knowledge obtained during the British Oncology Pharmacy Association (BOPA) Introduction to Oncology (ITO) Course.

The British Oncology Pharmacy Association (BOPA) Introduction to Oncology (ITO) course has run for over 20 years. The ITO course is provided free of charge to BOPA PAID members, and there was an increase in cost moving to a two-day event in 2023. The BOPA Education and Training (E&T) subcommittee and BOPA Executive Committee wanted to validate that the course was meeting its objective of improving the baseline knowledge of the pharmacists and pharmacy technicians attending, and therefore justifying the increased cost to BOPA and employing organisations. During the ITO course in November 2023, quantitative data was collected using a questionnaire-based survey with 5-point Likert scales. This was administered to delegates at the start of each respective day to assess baseline knowledge level. Another survey was administered at the end of each respective day to re-assess knowledge level. There is a positive overall change for all sessions. This ranged from a + 0.92 to +1.76 improvement across the board. This was applicable regardless of profession. For all responders the greatest improvement of knowledge was seen in A. 'Extravasation of SACT' session (+1.76), 'Oncological Emergencies' (+1.51) and 'The cancer patient pathway' (+1.51) B. those with less than 6 months experience (+1.54). This study has demonstrated that overall the ITO course improved the baseline knowledge of the delegates attending the course (+1.21). The delegates were also more confident in verifying SACT prescriptions after the course.

Consensus Building to Identify Nursing Research Priorities Among Oncology Nurses: A Delphi Study in a National Cancer Institute-Designated Comprehensive Cancer Center.

To advance oncology nursing science and clinical practice, researchers and clinicians must understand the important real-world concerns of nurses who provide direct care to people with cancer or manage processes that support patient care. This study developed a comprehensive compendium of real-world concerns among oncology nurses and built consensus regarding their importance. Using Delphi survey methodology, this prospective, descriptive study was performed in 3 phases: (1) identification of experts, defined as registered nurses (RNs) employed within a comprehensive cancer center; (2) qualitative content analysis of 353 responses from 267 RNs who responded to the question, "What do you see as nursing research concerns, problems, and/or issues on your unit or in your work environment that needs to be studied?"; and (3) rating the importance of 62 research themes identified from the qualitative content analysis (n = 247 RNs). The top research priority was patient safety followed by patient education, oncologic emergencies, patient expectations and adherence with care, team communication, patient psychosocial needs, patient-reported outcomes and quality of life, healthcare team burnout, workload, and nurse burnout. The findings support the nursing discipline's fundamental focus on patient safety, the top-rated nursing research priority, along with other patient-related and work environment issues. Oncology nursing is complex and complicated. This study identified and prioritized the real-world concerns, issues, and problems of oncology RNs who provide direct care or manage the processes that support care, supporting the need to focus on patient-related and work environment research.

Current gaps in emergency medicine core content education for oncologic emergencies: A targeted needs assessment.

The core content of emergency medicine (EM) residency training includes the management of oncologic emergencies; however, documented knowledge gaps continue to exist in this subtopic. This study represents a targeted needs assessment as indicated by Step 2 of Kern's curriculum design to determine the specific training gaps to be addressed within the oncologic EM curriculum. A multi-institutional cross-sectional survey of oncologists (surgical and medical) and emergency physicians (attendings and residents) was conducted during 2023 at five institutions. The voluntary survey consisted of general and specialty-specific questions exploring gaps in oncologic emergency-specific training/education topics. Descriptive statistics reported responses as frequencies and percentages. Of the 833 surveys sent across the five sites, 302 (36.3%) were accessed by link; of these, 271 (89.7%) surveys were completed. There were no differences in the responses between early and later respondents and no differences in the characteristics of respondents between sites. A vast majority of the oncologist and EM groups (91.2% and 83.0%, respectively) reported a belief that emergency physicians would benefit from additional oncologic emergency training. Our survey identified 16 important topics for inclusion in an oncologic EM curriculum, including five topics not present on the 2022 Model of Clinical Practice of Emergency Medicine. Based on this needs assessment, an oncologic EM curriculum should include the topics listed under oncologic emergencies in the 2022 Model of the Clinical Practice of Emergency Medicine along with our respondent-identified topics of radiation therapy adverse effects, stem cell transplant complications, and the management of cancer-specific postsurgical complications, pain, and common diseases in patients with cancer.

Decision making in oncology: Unleashing the power of artificial intelligence—Beyond the question of feasibility.

9021 Background: This study examines how consulting artificial intelligence (Chat GPT, Bard) or electronic tools (Apps, Journal or Guidelines) affects the decision-making process in Oncology Fellows. Methods: In the OSCE IOHM-USAL 2023, Oncology Fellows (2022 and 2023 cohorts) individually answered stations I and II, both spontaneously and after AI consultation. Group responses for stations III and IV were also gathered. Sign tests compared pre- and post-consultation responses in stations I and II while the impact of AI in stations III and IV was individually assessed on a five-point scale (0= Null and 5= Extremely useful). Results: 15 Oncology Fellows participated in OSCE 2023- 14 Females. Median age: 30 (r=28-36). A) Stations I - II Cases: Case1: 70 y. Non smoker. PS 0. Stage IV NSCLC. PS 0. EGFR mutated E746 _A750. PDL1 90%. Case 2: 52 y. Postmenopausal Stage II Luminal B Her2 negative Breast cancer (pT2, pN1, M0). Case 3: 35 yo. Advanced colon cancer. Stage IV. BRAF p(V600E) c.1799 A&gt;C. No Micorsatellite Instability. B) Station III (Ethics Committee), the following cases were addressed: 4. “BRCA1: Insured, not excluded”. 5. “Smoke vs. oath? Tough choice” 6. “Follow Lynch path, or HMO exit”. In all three cases, 3/15 students reported finding AI useful in the discussion. C) Station IV (Tumor board), the following cases were addressed: 7. “Postmenopausal NOS IBC (pT1c pNmic Luminal B Her2 negative)”. 8. “Oncology emergency in a 22 y male patient testicular tumor pending pathology”. In Case 7, 3/15 students reported finding AI useful in the discussion. In Case 8, 4/15 students reported finding AI useful. Conclusions: 1. A study of 15 oncology fellows found no appreciable influence of AI on clinical decision-making. 2. Analysis of eight cases (individual/collective) identified anchor value, optimistic denial, and confirmation bias in reasoning and processing. 3. Fellow training in critical AI analysis and outcome evaluation is imperative. [Table: see text]

Predictors of mortality among adults with acute lymphocytic leukemia in relapse with tumor lysis syndrome during chemotherapy.

e18510 Background: Tumor lysis syndrome (TLS), a common complication of chemotherapy, can be an oncologic emergency involving various complications, such as electrolyte imbalance, triggering a higher risk of mortality. We aim to understand the predictors of death among Acute lymphocytic leukemia (ALL) patients in relapse who experienced TLS during their chemotherapy admission. Methods: Our study focussed on ALL adults in relapse, ages≥ 18 years, from the 2016-2020 National Inpatient Sample (NIS) undergoing chemotherapy who experienced TLS. Multivariate regression analyses helped evaluate the impact of several patient characteristics on all-cause mortality. Results: Initially, a total of 11710 patients with ALL in relapse were found who were undergoing chemotherapy. Among them, an estimated 930 (7.9%) experienced TLS. The mortality rate among TLS patients was 14.0%, as 130 deaths were reported. Higher odds of mortality were noted among Females (vs. Males, aOR 2.169, 95% CI 1.188-3.959, p=0.012), patients with events of acute kidney injury (AKI) (aOR 2.006, 95% CI 1.096-3.672, p=0.024), hypertension (aOR 5.582, 95% CI 2.969-10.494, p&lt;0.01), cirrhosis (aOR 39.119, 95% CI 16.380-93.422, p&lt;0.01), presence of hyperkalemia (aOR 3.366, 95% CI 1.605-7.063, p&lt;0.01), or cardiac dysrhythmias (aOR4.630, 95% CI 2.063-10.391, p&lt;0.01). Meanwhile, lower odds of mortality were seen among people with diabetes (aOR 0.386, 95% CI 0.157-0.951, p=0.039). No racial disparities were noted between Blacks (aOR 1.806, 95% CI 0.730-4.471,p=0.201) and Hispanics (aOR 1.870, 95% CI 0.900-3.887, p=0.094) compared to Whites. Similarly, smoking status (aOR 0.466, 95% CI 0.196-1.110, p=0.085), events of acidosis (aOR 1.012, 95% CI 0.494-2.074, p=0.974), and patients of ages ≥60 years(vs.&lt;60 years, aOR 1.230, 95% CI 0.627-2.415, p=0.547) did not show any differences in mortality. Patients who died also had a more extended hospitalization (24.27 days vs. 20.15 days, p&lt;0.01), with a more expensive stay (mean hospital charge $600779 vs. $418867, p&lt;0.01). Conclusions: Our analysis confirms the burden of TLS in the prognosis of ALL patients undergoing chemotherapy. The mortality rate was higher for women and those with pre-existing comorbidities. However, people with diabetes have a lower risk, possibly due to close monitoring and prophylactic strategies. Notably, race, smoking status, acidosis, and age over 60 years did not show significant differences in mortality rates. Scaling the study to different healthcare organizations will help augment the sample size, assess the impact of treatment plans, and overcome limitations such as lack of disease duration, post-discharge follow-up, and potential diagnostic and coding errors.

Presentation and characteristics of patients with suspicion of cancer presenting to an oncologic emergency department

Presentation and characteristics of patients with suspicion of cancer presenting to an oncologic emergency department