Evaluation of Factors Associated with Oncological Emergencies in Hematological and Solid Malignancies

Aim:The number of patients with cancer admitted to emergency service (ES) is increasing daily, and oncologic emergencies (OEs) are a significant cause of mortality among these patients.In this study, we aimed to examine the reasons for ES visits of patients with cancer and to determine the frequency of OEs and related factors.Methods: Patients aged 18 years and older with malignant neoplasms admitted to our hospital's ES between 2017 and 2020 were retrospectively analyzed.Demographic and clinical characteristics, laboratory parameters, and diagnoses were obtained from the hospital's electronic database and patient files.In terms of diagnoses, they were classified as oncologic and other emergency diagnoses (OED), and statistical analyses were performed. Results:The study was completed in 1.593 patients.The median age was 59.The prevalence rates of hematologic and solid malignancies were 6.5% and 93.5%, respectively.Leukemia and gastrointestinal system malignancies were the most common hematological and solid malignancies.In total, 90.8% of the patients had metastases.Forty-eight point seven percent of the patients were diagnosed as OEs.Forty-nine point five percent of the patients were discharged from the ES, 48.2% were hospitalized, and 0.6% died at the ES.In total, 11.8% died in the ES or after hospitalization.The mortality rate in the OE group was 22.2%.OEs were more common in patients with hematological malignancies, with a 67.3% ratio (p<0.001).Among solid malignancies, OEs were more frequent in gynecological, lung and central nervous system malignancies (p<0.001).No significant difference was found between the OE and OED groups in terms of the presence of metastasis (p=0.108);therefore, when evaluated with the type of organ metastasis, OEs were more common in lung, brain, liver, and bone metastases (p<0.001).Admission to ES by ambulance, presence of comorbid diseases, higher Eastern Cooperative Oncology Group Performance Status Scale (ECOG PS), potassium, calcium, total bilirubin, C-reactive protein (CRP), and lactate values were associated with an increased risk of OE, whereas female gender, solid malignancy, and higher hemoglobin and blood urea nitrogen values were associated with a decreased risk of OE.A higher ECOG PS score [odds ratio (OR)=3.806,p<0.001], presence of brain metastasis (OR=3.225,p<0.01), higher CRP (OR=1.010,p<0.001) and lactate (OR=1.227,p<0.01) were found to be associated with mortality in patients with OE.Conclusion: Classifying cancer patients admitted to the ES as OEs and non-OEs may reduce the workload of ES, enable physicians to recognize OEs earlier, make rapid and accurate decisions appropriate to the situation, and provide emergency intervention for oncologic complications.