| Introduction: This dissertation, focused on cancer survivors from the time of cancer diagnosis, aims to: 1) Critically review existing evidence regarding the incidence and predictors of, and reasons for, ED visits; 2) Describe ED use, its predictors, and underlying reasons using publicly available data sets; and 3) Estimate the proportion of ED visits in this population deemed potentially avoidable.;Methods and Materials: A systematic review of ED use among cancer survivors was conducted using keyword and MeSH terms in four electronic databases. Next, cancer registry and California Office of Statewide Health Planning and Development linked discharge data (OSHPD) were used to describe ED use in the year following a cancer diagnosis. Medical Expenditure Panel Survey (MEPS) data (2008-2011) were used to compare ED use among cancer survivors, individuals with other chronic conditions, and those with no conditions using survey-weighted regression.;Results: In the systematic review, estimates of ED use by oncology patients were sparse and varied by timing from diagnosis, cancer type, and other population attributes. The 30-day standardized visit rate incidence ranged from 1-12%. Using CCR-OSPHD data, the incidence of ED use was 17% within 30 days, and 43% within 365 days, with most visits occurring within 180 days. The incidence also varied by cancer type (5-29% within 30 days; 22-69% within 365 days). Approximately 7% of visits within six months of diagnosis were classified as Ambulatory Care Sensitive Conditions and 12-34% were considered chemotherapy-related adverse events. Using MEPS, the odds of any ED use and number of visits were significantly higher for cancer survivors (OR=1.35 95% CI: 1.05-1.74; IRR=1.46 95% CI: 1.09-1.93) and individuals with chronic conditions (OR=1.39 95% CI=1.27-1.54; IRR=1.42 95% CI 1.27-1.57) compared to those reporting no conditions.;Conclusion: Cancer patients and survivors use EDs at higher rates than previously reported, with considerable variability by cancer type. Existing methods to identify potentially avoidable ED visits may not be sufficient for this population. Future research is recommended to focus on reasons for ED visits by cancer type and developing models of specific predictors of ED use while accounting for treatment and comorbid conditions. |
