Millions of cancer patients visit hospital emergency departments each year for a variety of issues, including fevers during chemotherapy and severe pain. However, emerging research highlights that these visits might not only be driven by physical symptoms. A systematic review published in Supportive Care in Cancer investigates the role of anxiety, revealing important insights about its impact on emergency care utilization among cancer patients.
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Led by Hong-Ying Chung of Griffith University and collaborators from the University of Toronto and Sinai Health, the study aimed to determine whether cancer patients experiencing anxiety utilize emergency services more than those who do not. This investigation is crucial as anxiety affects up to 30% of cancer patients at some point post-diagnosis, and understanding its influence on emergency visits is vital for improving care and managing service demands.
The research encompassed a comprehensive search across six major databases, leading to the identification of seven relevant studies. While all these studies compared emergency department usage between anxious and non-anxious cancer patients, they differed significantly in how they defined and measured both anxiety and emergency use. For example, some studies used administrative diagnostic codes, while others used patient-reported measures, potentially capturing subclinical anxiety.
The review’s findings were mixed. Four of the studies found no significant association between anxiety and emergency department visits, suggesting patients with anxiety did not utilize emergency services at markedly different rates than their non-anxious peers. However, these studies reported effect sizes close to 1.0, indicating a possible trend. In contrast, three studies indicated a statistically significant positive association between anxiety and increased emergency department usage, with odds ratios ranging from 1.23 to as high as 3.87. This suggests that anxious patients are up to four times more likely to seek emergency care compared to their non-anxious counterparts.
The review raises questions about why anxiety may propel cancer patients toward emergency departments. It speculates that anxious individuals may misinterpret physical sensations—such as fatigue or nausea—as signs of disease progression, prompting them to seek urgent care. Additionally, anxiety could intensify the perceived severity of symptoms, lowering the threshold for seeking help. This aligns with existing literature, which links anxiety to higher healthcare utilization across different patient populations.
The implications for clinical practice and policy are significant, as unplanned emergency visits can lead to hospitalizations, disrupted treatment plans, and increased costs. If anxiety proves to be a substantial factor in driving emergency department visits, effective interventions such as routine psychological screenings and integrated mental health services in oncology could help redirect care away from emergency settings.
However, the authors caution against drawing firm conclusions due to the heterogeneous nature of the evidence and the limitations of the studies, including the retrospective designs. They emphasize the need for prospective longitudinal research employing standardized anxiety assessments throughout the cancer care continuum, which would clarify the relationship between anxiety and acute care utilization.
In summary, the review provides a crucial reminder for clinicians: when treating cancer patients in emergency departments, the influence of anxiety should not be overlooked. Considering the psychological dimensions of care could enhance patient management, particularly in a healthcare system grappling with high acute care demands.