Emergency Department Use in Adolescent and Young Adult Cancer Early Survivors from 2006 to 2020 - PubMed (original) (raw)

. 2024 Oct;13(5):738-747.

doi: 10.1089/jayao.2023.0174. Epub 2024 Apr 29.

Eric C Haupt 3, Neetu Chawla 4, Thearis Osuji 3, Ernest Shen 3, Andrew B Smitherman 5, Mallory Casperson 6, Anne C Kirchhoff 7, Bradley J Zebrack 8, Theresa H M Keegan 9, Lawrence Kushi 10, Christopher Baggett 5, Heydon K Kaddas 7, Kathryn J Ruddy 11, Candice A M Sauder 12, Theodore Wun 9, Marlaine Figueroa Gray 1, Jessica Chubak 1, Hazel Nichols 5, Erin E Hahn 2 3

Affiliations

Emergency Department Use in Adolescent and Young Adult Cancer Early Survivors from 2006 to 2020

Karen J Wernli et al. J Adolesc Young Adult Oncol. 2024 Oct.

Abstract

Purpose: Understanding emergency department (ED) use in adolescent and young adult (AYA) survivors could identify gaps in AYA survivorship. Methods: We conducted a cohort study of 7925 AYA survivors (aged 15-39 years at diagnosis) who were 2-5 years from diagnosis in 2006-2020 at Kaiser Permanente Southern California. We calculated ED utilization rates overall and by indication of the encounter (headache, cardiac issues, and suicide attempts). We estimated rate changes by survivorship year and patient factors associated with ED visit using a Poisson model. Results: Cohort was 65.4% women, 45.8% Hispanic, with mean age at diagnosis at 31.3 years. Overall, 38% of AYA survivors had ≥1 ED visit (95th percentile: 5 ED visits). Unadjusted ED rates declined from 374.2/1000 person-years (PY) in Y2 to 327.2 in Y5 (p change < 0.001). Unadjusted rates declined for headache, cardiac issues, and suicide attempts. Factors associated with increased ED use included: age 20-24 at diagnosis [relative risk (RR) = 1.30, 95% CI 1.09-1.56 vs. 35-39 years]; female (RR = 1.27, 95% CI 1.11-1.47 vs. male); non-Hispanic Black race/ethnicity (RR 1.64, 95% CI 1.38-1.95 vs. non-Hispanic white); comorbidity (RR = 1.34, 95% CI 1.16-1.55 for 1 and RR 1.80, 95% CI 1.40-2.30 for 2+ vs. none); and public insurance (RR = 1.99, 95% CI 1.70-2.32 vs. private). Compared with thyroid cancer, cancers associated with increased ED use were breast (RR = 1.45, 95% CI 1.24-1.70), cervical (RR = 2.18, 95% CI 1.76-2.71), colorectal (RR = 2.34, 95% CI 1.94-2.81), and sarcoma (RR = 1.39, 95% CI 1.03-1.88). Conclusion: ED utilization declined as time from diagnosis elapsed, but higher utilization was associated with social determinants of health and cancer types.

Keywords: AYA; cancer survivorship; emergency department; health services.

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Figures

FIG. 1.

FIG. 1.

Rates of emergency department utilization by time since diagnosis in AYA cohort diagnosed from 2006 to 2020 by: (A) Age at diagnosis; (B) sex at birth; (C) race and ethnicity; (D) cancer type. AYA, adolescent and young adult.

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