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Table 2 Detailed description of studies included (n = 49)

From: Understanding oncologic emergencies and related emergency department visits and hospitalizations: a systematic review

Author, year

Country

Methods

Population

Sample Size

Age, years (Mean, SD, or Median)

% Male

Cancer Studied

Oncologic Emergency Studied

Intervention Used in the ED/Hospital

Abelson et al., 2017 [29]

United States

Retrospective Observational Cohort Study

Patients admitted to the ED with MLBO who were treated with palliative stent (n = 172) or stoma (n = 173)

345

69.9 (14.4) (stoma group), 70.9 (16.8) (stent group)

87 (50.3%, stoma); 90 (52.3% stent)

Colorectal

palliation of malignant large-bowel obstruction (MLBO)

Palliative stenting or stoma creation

Alsirafy et al., 2016 [30]

Other: Egypt

Retrospective Observational Cohort Study

Patients with terminal cancer who died at KAMC-HC during the 13-month period

154

Median (range): 60 (16–91)

69 (44.8%)

All

Pain, dyspnea, vomiting

n/a

Azoulay et al., 2021 [31]

Other: France, Spain, USA, UK, Russia, Canada, Germany, Austria

Retrospective Observational Cohort Study

Patients who received CAR T-cell therapy in the past 30 days had been admitted to the ICU for any reason

241

Median (range): 58 (43–66)

144 (60%)

All hematological malignancies

Isolated cytokine release syndrome, sepsis (due to pneumonia, enterocolitis, and skin and soft tissue infections), frailty

Life-saving treatments (vasoactive drugs), non-invasive ventilation or high-flow nasal oxygen, steroid therapy,

Banala et al., 2020 [32]

United States

Randomized Clinical Trial

Adult patients with cancer presenting with severe pain to the ED

84

Median (range): IV Hydromorphone group: 51 (29–78); Intranasal Fentanyl group)55 (22–84)

36 (43.9%)

All

Severe pain

Intranasal fentanyl (INF) vs intravenous hydromorphone (IVH)

Bosscher et al., 2016 [33]

Other: The Netherlands

Prospective Observational Cohort Study

Adult cancer patients (age [18 years) in the University Medical Center Groningen who required surgical consultation for oncologic emergencies

207

Not reported

101 (48.8%)

All

Obstruction, infection, clinical deterioration, gastrointestinal perforation, bleeding/thrombosis, pathological fractures

Referral to surgery within 30 days after emergency evaluation or non-surgical treatment

Bou Chebl et al., 2021 [34]

Other: Lebanon

Retrospective Observational Cohort Study

All patients > 18 years of age admitted with sepsis

442

67.92 (13.32, solid tumor); 55.37 (20.85, hematological malignancy)

190 (62.3% solid); 97 (70.8% hematological)

All

Sepsis

IV fluids, Vasopressor use, steroid use, intubation

Bow et al., 2006 [35]

Other: USA, Canada, Australia

Randomized Clinical Trial

Patients at high risk for medical complications who were > = 18 years old, severely neutropenic, hospitalized for the management of a febrile episode complicating the course of cytotoxic therapy for a hematological malignancy or for a hematopoietic stem cell transplant (HSCT), and who had provided written, informed consent according to institutional protocol

264

50.2 (15.1, Piperacillin-tazobactam recipients); 50.1 (14.5, Cefepime recipients)

166/265 (62.6% Piperacillin-tazobactam recipients); 146/263 (54.4% Cefepime recipients)

All Hematological malignancies

Febrile neutropenic episodes

n/a

Castillo et al., 2021 [36]

United States

Retrospective Observational Cohort Study

Patients receiving ICI therapy within 6 weeks before ED presentation who had a contemporary evaluation in the Mayo Clinic Hospital ED between May 1, 2017, and April 30, 2018

67

Median (range): 65 (24–88)

36 (53.7%)

All

Immune-related adverse events (abdominal pain, colitis, diarrhea, hyperglycemia, shortness of breath, dizziness, chest pressure/tightness, nausea and vomiting)

Corticosteroids (dexamethasone 10 mg, prednisone 60 mg)

Cauley et al., 2015 [37]

United States

Retrospective Observational Cohort Study

Patients included in this study were at least 18 years old, had a preoperative diagnosis of disseminated cancer and Patients who underwent an emergency operation for intestinal obstruction or perforation by the primary DRG International Classification of DiseasesV9th Rev. (ICD-9) code

875

Not reported

52% (in intestinal perforation group); 51% (in Obstruction group)

All

Intestinal Obstruction or Perforation

Emergency Operation

Chou et al., 2012 [38]

Other: Taiwan

Retrospective Observational Cohort Study

Consecutive patients with stage III to stage IV lung cancer, who were admitted to ICU for sepsis-related respiratory failure

70

71.7 (12.3, survived to hospital discharge); 76.4 (11.6, died)

23 (79.3% survived to hospital discharge); 37 (90.2% died)

Lung, stage III and IV

Sepsis-related respiratory failure

Intubated via mechanical ventilator support. If patients failed to be weaned from the ventilator, they were transferred to a respiratory care facility for long-term ventilator support

Cooksley et al., 2020 [39]

UK

Prospective Observational Cohort Study

All emergency presentations in patients treated with ICIs within 6 months before admission were seen at a specialist oncology hospital in England from 20th May 2018 to 19th May 2019

300

Median (range): 67 (28–88)

185 (61.7%)

All

Dyspnea, diarrhea, and fever related to ICI toxicity

Steroids, antibiotics

Coyne et al., 2021 [40]

United States

Prospective Observational Cohort Study

Adults 18 years or older with active cancer presenting to the ED

1075

Median (range): 64 (19–90)

518 (48.2%)

All

Pain

Opioids, acetaminophen

Delgado-Guay et al., 2015 [41]

United States

Retrospective Observational Cohort Study

Patients with advanced cancer aged 18 years or older who visited the ED after their first visit to an outpatient palliative care clinic

200

56.5 (13.6)

104 (52%)

All

pain, GI symptoms, altered mental status, other neurologic symptoms, infection, dyspnea, fever/chill, bleeding, edema/swelling, constipation, general weakness, fell down

received palliative care consultation in the ED or admitted to the hospital

DeSilva, Jackson, and Steer, 2018 [42]

Australia

Retrospective Observational Cohort Study

Patients ≥ 18 years of age who were admitted under the oncology unit at Albury Wodonga Health during a 12-month period and who had a microbiological test performed for suspected infection during their admission

208

Median (range): 67 (19–89, with febrile neutropenia); 68 (19–89, without febrile neutropenia)

28 (56% with febrile neutropenia); 99 (62.7%, without febrile neutropenia)

All

Infection, neutropenic fever episodes

Antibiotic therapy

Frago et al., 2010 [43]

Other: Spain

Retrospective Observational Cohort Study

Patients with stage IV obstructing CRC presenting to the ED

55

65.5 (50–77, surgery group); 65.9 (19–84, stent group)

9/12 (75% surgery group); 32/43 (74.41%, stent group)

Colorectal, stage IV

Bowel obstruction

Colonic stenting or palliative chemotherapy (consisting of a combi-nation of 5-fluorouracil (5-FU), leucovorin (LV), and irino-tecan (FOLFIRI) or oxaliplatin (FOLFOX))

Giustozzi et al., 2021 [44]

Other: Italy, USA, Belgium, France, Germany, Israel, Netherlands, UK, Poland, and Spain

Randomized Clinical Trial

Patients with cancer with symptomatic or incidental acute proximal deep vein thrombosis or pulmonary embolism were randomized in a 1:1 ratio to receive oral apixaban or subcutaneous dalteparin

1155

67.3 (11.0, incidental VTE); 68 (11.2, Symptomatic VTE)

115 (50%, incidental VTE); 453 (49%, symptomatic VTE)

All

Incidental or symptomatic acute proximal deep venous thromboembolism (VTE)

Lab testing, diagnostic imaging

Grewal et al., 2020 [45]

Canada

Retrospective Observational Cohort Study

Patients aged 18 years and older with a cancer diagnosis and who received chemotherapy in the 30 days before being seen in an emergency department between 2013 and 2017

87,555

66 (56–74)

39,383(45%)

All

Infection, fever, gastrointestinal diagnoses

Specialty consultation, hospital admission

Gudiol et al., 2016 [46]

Other: Spain

Prospective Observational Cohort Study

Advanced solid neoplasm was considered in patients with confirmed metastatic disease (stage IV) and some tumors in stage III (lung, pancreas, gastric, esopha-geal and urothelial) not suitable for curative treatment

795

64 (29–89)

35 (63.6%)

All

Bacteremic pneumonia in neutropenic cancer patients, fever, cough, septic shock,

ICU admission, invasive mechanical ventilation, antibiotic therapy, targeted antibiotic therapy

Hsu et al., 2021 [47]

Other: Taiwan

Retrospective Observational Cohort Study

Adults with cancer who received palliative care during the final 6 months of their life

762

70.4 (13.0)

44 (49.4%)

All

Anemia, altered mental status, catheter-related events, dyspnea, falls, fever, N/V or other GI symptoms, pain, and tumor bleeding/complications

n/a

Kao et al., 2018 [48]

Other: Taiwan

Case–Control Study

Advanced cancer patients receiving palliative home care services

65

72.6 (12.1)

35 (54.8)

All

Pain, infection or fever, nausea or vomiting, constipation, dyspnea, change of consciousness, and gastrointestinal bleeding

Morphine

Kerhuel et al., 2015 [49]

Other: France

Retrospective Observational Cohort Study

All patients admitted to the ICU within the 3 months following HDT/ASCT during the study period

27

54 (38–60)

14 (52%)

Lymphoma

Infection, shock, acute respiratory failure, neurologic disorder, bleeding

Vasopressors, invasive mechanical ventilation, non-invasive mechanical ventilation, renal replacement therapy

Kim et al., 2014 [50]

Other: Korea

Retrospective Observational Cohort Study

Patients with pathologically confirmed lung cancer who were admitted to the medical ICU at Seoul National Uni-versity Bundang Hospital between 2003 and 2011

95

65.6 (10.3)

78 (82%)

Lung, stage IIIB and IV

Obstructive pneumonia, respiratory failure due to lung involvement of cancer, cardiac tamponade, tumor bleeding, neurologic events, metabolic events, radiation pneumonitis, chemo-induced lung toxicity, infection with neutropenia, infection without neutropenia, other complications due to treatment, neutropenic septic shock, comorbidity related events

Vasoactive agents, hemodialysis, CPR, mechanical ventilation

Klamroth et al., 2022 [51]

Other: Germany

Prospective Observational Cohort Study

Patients diagnosed with cancer-associated venous thrombosis with newly diagnosed symptomatic or asymptomatic VTE, pulmonary embolism (PE), or deep vein thromboses (DVT) and age ≥ 18 years

382

Median is 67 years for patients with CAT

189 (49.5%, patients with CAT)

All

Cancer-associated venous thrombosis (CAT)

Anticoagulant therapy with low-molecular weight heparin, direct oral anticoagulants, Vit K antagonists, unfractionated heparin

Lagman et al., 2007 [52]

United States

Prospective Observational Cohort Study

Patients who were admitted to The Harry R. Horvitz Acute Inpatient Palliative Medicine Unit with an episode needing acute inpatient treatment for symptom control or management of complications

96

62 (31–92)

48 (50%)

All

Acute inpatient treatment of symptom control and cancer-related complications (i.e., neutropenic fever, radiation-induced pneumonitis, intractable emesis), terminal care, antineoplastic therapy-induced complications, comorbid condition related symptoms

Invasive diagnostic (i.e., endoscopy) and therapeutic procedures, medications (i.e., opioids, laxatives, acid suppressants, corticosteroids, antiemetics), hydration, transfusions, radiation or chemo or a combination, discharged home with hospice care, lab tests, radiologic investigations

Mercadante et al., 2010 [53]

Other: Italy

Prospective Observational Cohort Study

Patients consecutively admitted to a Pain Relief and Palliative Care unit in a period of 6 months from January 2008 to June 2008, who were receiving opioids in doses of oral morphine equivalents equal to or more than 60 mg daily or who were prescribed opioids for breakthrough pain (BTP) of different nature

66

66.7 (12.2)

42 (63.6%)

All

Pain

Opioids intravenous, oral, transdermal

Mercadante et al., 2017 [54]

Other: Italy

Prospective Observational Cohort Study

Advanced cancer patients who were admitted to an APSCU

235

66.7 (11.9, first admission); 62.7 (11.9, readmission)

134 (57%, first admission); 48 (60.8% readmissions)

All

Uncontrolled pain, opioid-induced toxicity, chemotherapy-induced toxicity, symptom control, and end-of-life care

Opioid therapy

Miranda et al., 2016 [55]

Other: Brazil

Cross-Sectional Study

Patients with cancer treated at oncological service and attended an ED for oncologic monitored from September 2011 to December. 2011, with length of stay > 2 h, aged 18 years or older

191

Not reported

68 (35.6)

All

Infection, pain, GI symptoms, respiratory symptoms,

n/a

Moghnieh et al., 2015 [56]

Other: Lebanon

Retrospective Observational Cohort Study

Adult cancer patients with fever and neutropenia, including those undergoing Hematopoietic Stem Cell Transplantation (HSCT), with positive blood cultures were selected

70

Not reported

36 (48%)

All

Febrile neutropenia

n/a

Numico et al., 2015 [57]

Other: Italy

Retrospective Observational Cohort Study

Patients admitted to the General Valle d’Aosta Hospital inpatient oncology ward between August 1, 2011 and December 31 2012

454

69.2 (26–92)

258 (56.9%)

All

Breathlessness, pain, fever, intestinal obstruction, other digestive symptoms (nausea and vomiting, jaundice, diarrhea, dysphagia, etc.), neurological symptoms (mainly related to brain metastases or meningeal carcinomatosis), general symptoms (such as fatigue and cachexia) and cardiovascular symptoms (such as those related to deep vein thrombosis, pericardial effusion, heart failure)

Imaging, antitumor interventions, antibiotics, opiates, diagnostic or therapeutic invasive procedures (thoracentesis for pleural effusion or biliary drainage for obstruction), chemotherapy or radiotherapy, transferred to hospice, or in-hospital death

Patel et al., 2017 [58]

United States

Retrospective Observational Cohort Study

Opioid-tolerant cancer patients > 18 years old who presented to two urban tertiary-care EDs between January 1, 2012 and November 30, 2014 and received opioids for the management of acute pain

216

Mean (range): 58 (29–89)

92 (42.40%)

All

Pain

Opioids

Peyrony et al., 2021 [59]

Other: France

Cross Sectional Study

Patients of 18 years or older with solid or hematologic malignancy

1081

72 (62–82)

611 (56.52%)

All

Dyspnea, neurological disorder, and fatigue

Ultrasound, blood tests, ECG, venous access, oxygen therapy, mechanical ventilation, existing tracheostomy use, fluid challenge, catecholamines, analgesia, morphine, CPR, sedation, antibiotics,

Poutsiaka et al., 2007 [60]

United States

Prospective Observational Cohort Study

All patients receiving daptomycin resided on the Bone Marrow Transplant Units of the two participating institutions (Tufts-New England Medical Center, Boston Massachusetts and the University of Iowa Hospital, Iowa City, Iowa) from 2000 to 2002

9

Mean (range): 52.9 (25–70)

7/9 (77.8%)

All hematological malignancies

Treating VRE BSI in febrile neutropenic patients

Daptomycin

Raghavendra et al., 2014 [61]

United States

Retrospective Observational Cohort Study

Patients with neutropenic fever with fever > 38.8 degrees Celsius

215

Median is 69 years

Not reported

All

Neutropenic fever

Antibiotics and infectious disease consult service use

Rolston et al., 2010 [62]

United States

Prospective Observational Cohort Study

Patients with neutropenic fever

21

44 (24–84)

4 (19%)

All solid tumors

Neutropenic fever

Physical exam, lab tests, oral moxifloxacin

Ruiz-Artacho et al., 2018 [63]

Other: USA, Argentina, Austria, Belgium, Brazil, China, Colombia, Czechia, Ecuador, Egypt, France, Germany, Greece, Honduras, Iran, Ireland, Israel, Italy, Japan, Latvia, Morocco, North Macedonia, Portugal, Spain, Switzerland, UK, Vietnam,

Prospective Observational Cohort Study

Patients with biopsy-proven active cancer in the lung presenting with acute symptomatic, objectively confirmed VTE

1725

65 (12.0, both pulmonary embolism and deep VT groups)

873 (72%, Pulmonary embolism); 377 (73%, Deep VT)

Lung

Recurrent DVT, or PE and major bleeding

Anticoagulant therapy, repeat compression ultrasonography, helical CT pulmonary, ventilation–perfusion lung scintigraphy, angio-graphy, or pulmonary angiography

Sandgren et al., 2010 [64]

Other: Sweden

Cross Sectional Study

Palliative cancer patients

520

70 (62, 71, 79 quartiles, 2002 DATA); 74 (67, 76, 83, 2007)

107 (55.7%, 2002); 182 (55.5%, 2007)

All

Pain, deterioration, nausea, infection

n/a

Skiba et al., 2020 [65]

Australia

Retrospective Observational Cohort Study

Adult cancer patients with a recorded diagnosis of neutropenic fever who were hospitalized at a tertiary care hospital between January 2017 and December 2017

88

64 (12.25)

31 (35.2)

All solid tumors

Neutropenic fever

Antibiotics

Soares, Martins, and Uchoa, 2003 [66]

Other: Brazil

Prospective Observational Cohort Study

Patients with severe cancer pain admitted to our palliative care center’s emergency room between April 2001 and June 2002 and aged between 18 and 80, on concurrent morphine therapy for at least 2 weeks, and had severe pain at initial assessment

18

51 (34–74)

10 (55.5%)

All solid tumors

Severe pain

IV fentanyl

Sutradhar, Barbera, and Seow, 2017 [67]

Canada

Retrospective Observational Cohort Study

Each decedent had to be at least 18 years of age at cancer diagnosis and had to have received homecare nursing (with standard or palliative intent) prior to their date of death

54,743

Not reported

26,913 (47.9%)

All

Dyspnea, malaise and fatigue, acute abdominal or pelvic pain, fever with chills, pain in throat, projectile vomiting, nausea, disorientation, rheumatism or other soft-tissue disorders, panniculitis affecting regions of next and back multiple sites in spine

n/a

Teimouri et al., 2022 [68]

Canada

Retrospective Observational Cohort Study

Adult medical oncology patients (≥ 18 years of age) with an NSH-CZ postal code who had received at least one dose of nivolumab, ipilimumab, or the nivolumab plus ipilimumab combination for cancer treatment at the Victoria General Hospital

129

64 (11.0)

84 (65.1%)

All

Diarrhea/colitis, hepatitis, pneumonitis, nephrotoxicity, and cardiotoxicity

Steroids

Verhoef et al., 2020 [69]

Other: Netherlands

Retrospective Observational Cohort Study

Adult patients who visited the ED between May 2011 and June 2014, included those who were in the palliative phase of cancer at the moment of the ED visit and died within 3 months thereafter

420

63 (22–92)

229 (54.5%)

All

Dyspnea, pain, and ascites

Imaging and blood tests, EOL goals of care discussions, hospitalizations

Verhoef et al., 2020 [70]

Other: Netherlands

Retrospective Observational Cohort Study

All adult patients with HM who died within 3 months after their last ED visit were included. They were compared to patients. with ST having advanced cancer, which was defined as not having any curative options or receiving anticancer treatment not aimed at curation

498

63 (22–94, all); 61 (27–94, HM); 61 (22–92, ST)

282 (56.6%, all); 53/78 (67.9%, HM); 229/420 (54.5%, ST)

All

Dyspnea, pain, fever, nausea or vomiting, neurologic deterioration, weakness or loss of strength, bleeding, obstipation or diarrhea, fatigue, difficulty swallowing or passage problems, seizure, edema, ascites

Diagnostic imaging, laboratory tests, hospitalization

Waddle et al., 2015 [71]

United States

Retrospective Observational Cohort Study

Cancer patients who initiated external beam RT at the University of North Carolina at Chapel Hill from January 1, 2010, through December 31, 2010

1116

Not reported

534 (47.85%)

All

GI symptoms, neurologic symptoms, respiratory symptoms, pain, fever or infection

n/a

Won et al., 2014 [72]

Other: Korea

Retrospective Observational Cohort Study

Patients aged 20 years and older, who stayed in the CED for more than 24 h and experienced pain with self-reported numeric rating scale (NRS) scores of 4 or greater at the time of admission or during the CED stay

455

53.9 (11.9, before CPCP); 56.2 (11.4, after CPCP)

81 (50%, before CPCP); 159 (55%, after CPCP)

All

Pain

Regular, time-release analgesics and immediate-release analgesics

Woon et al., 2021 [73]

Canada

Retrospective Observational Cohort Study

All men aged 66 and older who received abiraterone or enzalutamide as first-line (chemotherapy-naïve) treatment for mCRPC between January 1, 2012, and December 31, 2017 in Ontario, Canada

3405

78.9 (7.2 overall)

3405 (100%)

Prostate

UTI, treatment-related toxicity

n/a

Xia and Wang, 2016 [74]

Other: China

Retrospective Observational Cohort Study

Patients aged ≥ 18 years; medical patients with a definite diagnosis of solid cancer according to pathological results obtained by surgical or micro-invasive biopsy; tumor metastasis assessed by radiography or exfoliative cytology; life expectancy evaluated by an oncologist as > 3 months; > 3 days in the ICU; and nonpregnant women

141

63 (54–74)

87 (61.7%)

All solid tumors

Respiratory failure, severe sepsis or septic shock, acute renal failure, acute heart failure

Vasopressors, mechanical ventilation, renal replacement therapy

Yaman et al., 2022 [75]

Other: Turkey

Prospective Observational Cohort Study

Patients 18 years or older, having hematological cancer, having laboratory TLS or clinical TLS, and receiving a single dose (7.5 mg) rasburicase

82

64 (19–85)

43 (52.4%)

All hematological malignancies

Tumor lysis syndrome (TLS)

Rasburicase administration

Yildirim and Tanriverdi, 2014 [76]

Other: Turkey

Retrospective Observational Cohort Study

Patients > 18 yrs of age with cancer treated or followed at the Department of Medical Oncology of our institution between August 2011 and September 2013

107

51 (11.0, group 1); 52 (13.0, group 2)

41 (64%, group 1); 21 (49%, group 2)

All

Dyspnea, pain, deterioration in general health status, fever, hemorrhage, icterus, abdominal distention/ascites, neurological symptoms

Pain treatment (fentanyl vs. tramadol vs. morphine), discharged, died in the ED, hospitalized

Yilmaz et al., 2017 [77]

Other: Turkey

Randomized Clinical Trial

Adults 18 to 65 years of age presenting to the ED with lung cancer and dyspnea; presentation to the ED with the complaint of shortness of breath and, such as dyspnea on exertion, wheezing, and accessory muscle use; not requiring assisted ventilation, peak expiratory flow rate (PEFR) of < 250

91

Mean (95%CI): 54.7 (51.8–57.7)

46 (50.5%)

Lung

Dyspnea

Salbutamol and magnesium sulfate

  1. Abbreviations: ED Emergency Department, MLBO Malignant large-bowel obstruction, KAMC-HC King Abdullah Medical City Health Clusters, CAR Chimeric Antigen Receptor, ICU Intensive Care Unit, IV Intravenous, INF Intranasal Fentanyl, IVH Intravenous Hydromorphone, HSCT Hematopoietic Stem Cell Transplant, ICI Immune Checkpoint Inhibitors, ICD-9 International Classification of Diseases V9th Rev., GI Gastrointestinal, CRC Colorectal Cancer, VTE Venous Thromboembolism, HDT High-dose Therapy, ASCT Autologous Stem Cell Transplant, PE Pulmonary Embolism, DVT Deep Vein Thromboses, CAT Cancer-associated Venous Thrombosis, BTP Breakthrough Pain, APSCU Acute Palliative-Supportive Care Unit, ECG Electrocardiogram, CPR Cardiopulmonary Resuscitation, VRE Vancomycin-Resistant Enterococcus, BSI Blood Stream Infection, EOL End of Life, HM Hematemesis and Melena, CED Coverage with Evidence Development, NRS Numeric Rating Scale, UTI Urinary Tract Infection, TLS Tumor lysis Syndrome