Acil Servise Başvuran Onkoloji Hastalarının Klinik Semptomlara Göre Dağılımının Değerlendirilmesi

Yıl 2022, Cilt: 15 Sayı: 1, 20 - 28, 30.04.2022

Dilek Atik

https://doi.org/10.52976/vansaglik.860904

Öz

Amaç:Kanser, sistemik bir hastalık olup her evresinde tüm sistemleri farklı şekilde etkileyebilir. Kanserli hastalar mevcut malignitelerinin doğrudan veya dolaylı neden olduğu akut semptomlar nedeniyle sıklıkla acil servise başvurmaktadırlar. Bu çalışma ile acil kliniğine başvuran onkoloji hastalarının başvuru nedenleri ve sık karşılaşılan problemlerinin araştırılması amaçlanmıştır.Yöntem: Bu çalışma kesitsel retrospektif bir çalışmadır. Bu başvurulardan acil servisteki değerlendirme sonunda acil servis tanılarının yanında ICD-10’a göre malign neoplazm tanılarından değerlendirilip, hasta kayıt bilgisayarına kaydedilen 18 yaş ve üzerindeki tüm olgular örneklemi oluşturmaktadır. Hastaların demografik incelemesinde betimleyici istatistlik kullanıldı. Çalışmada verileri değerlendirilirken nitel olması halinde ki-kare( χ² ) testi veya Fisher exact testi uygulandı.Bulgular: Belirtilen dönemde çalışmaya 43’ü (%58.1) kadın, 32’si (%42.6) erkek olmak üzere 75 hasta dahil edildi. En sık rastlanılan şikayet %77( n=57) ağrı şikayeti olup sırası ile %36.5(n=26) nefes darlığı, %35.1(n=25) bulantı-kusma idi. Hastalarda mevcut maligniteler içinde en sık görülen ilk üç kanser sırasıyla akciğer %26.7(n=20), %14.6 (n=11) prostat ve %10.7(n=8) meme kanserleri idi. Sonuç: Günümüz şartlarında artan malignite hastalarının hem kanser hastalığına bağlı hemde tedavi protokollerinden dolayı yaşam kaliteleri düşmektedir. Özellikli bu hasta grubu hem hastalığın vücuda yansıdığı rahatsızlık hem de tedavi esnasında oluşan yan etkilerden dolayı ileri dönemlerde bu özellikli hasta grupları için onkoloji uzmanları ile işbirliği ile acil tıp kliniklerine üniteler açılabileceği ve acil servis planlamalarında özel yaklaşım politikalarının belirlenmesinde katkı sağlayacağı kanısındayız.

Anahtar Kelimeler

Oncoloji hastaları, Maligniteye bağlı semptomlar, Acil servis

Evaluation of The Distribution of Oncology Patients Admitting to Emergency Department According to Clinical Symptoms

Öz

Aim: Cancer is a systemic disease, and can affect all systems differently at each stage. Cancer patients often admit emergency departments due to acute symptoms directly or indirectly caused by their current malignancies. With this study, the purpose was to investigate the causes of admission and common problems of oncology patients admitting to the emergency department.Method: This study has a cross-sectional and retrospective design. At the end of the evaluation in the emergency department, all cases who were aged 18 and over, who were evaluated based on malignant neoplasm diagnoses according to ICD-10, and recorded in the patient registration computer made up the study sampling. Descriptive statistics were used in the demographic examination of the patients.In the study, in case the data were qualitative, the Chi-Square (χ²) Test or Fisher’s Exact Test were used.Results:A total of 75 patients were included in the study during the specified period, including 43 (58.1%) women and 32 (42.6%) men. The most common complaint was pain with 77% (n=57), followed by shortness of breath with 34.6% (n=26), and %33.3(n=25) nausea and vomiting. In patients, the top 3 most common malignancies were lung 26.7% (n=20), 14.6% (n=11) prostate, and 10.7% (n=8) breast cancer, respectively.Conclusion:In today’s conditions, the quality of life of patients with increased malignancies is reduced because of the cancer disease and treatment protocols. We believe that specific units can be opened in emergency medicine clinics in cooperation with oncology specialists for this patient group in the future because of the discomfort in which the disease is reflected in the body, and due to the side effects that occur during treatment, which will contribute to the determination of special approach policies in emergency department planning.

Anahtar Kelimeler

Oncology patients, symptom due to the malignancy, emergency department

Kaynakça

• 1. Tuik Olum Nedeni Istatistikleri. İSTAhttps://data.tuik.gov.tr/Bulten/Index?p=Olum-Nedeni-Istatistikleri-2018-30626.
• 2. Cancer. Geneva: World Health Organization; 2018. Available: www.who.int/mediacentre/factsheets/fs297/en/ (accessed 2019 Mar. 29).
• 3. Rivera DR, Gallicchio L, Brown J, Liu B, Kyriacou DN, Shelburne N. Trends in adult cancer-related emergency department utilization: an analysis of data from the Nationwide Emergency Department Sample. JAMA Oncol. 2017;3(10):e172450.
• 4. Klemencic S, Perkins J. Diagnosis and Management of Oncologic Emergencies. West J Emerg Med . 2019 Mart; 20 (2): 316–322.
• 5. Bozdemir N, Eray O, Eken C, Şenol Y, Artaç M, Samur M. Demographics, clinical presentations and outcomes of cancer patients admitted to the emergency department. Turk J Med Sci. 2009;39(2):235-40.
• 6. Dunne-Daly CF. Radiation Therapy for oncological emergencies. Cancer Nurs 17: 516-527,1994.
• 7. Neilan BA. Oncologic emergencies. Postgrad Med 95: 125-32, 1994.
• 8. McCarthy EP, Philips RS, Zhong Z, Drews RE, Lynn J. Dying with cancer: patients' function, symptoms, and care preferences as death approaches. J Am Geriatr Soc. 2000;48(S1):S110-21.
• 9. Bluethmann SM, Mariotto AB, Rowland JH. Anticipating the “silver tsunami:” prevalence trajectories and comorbidity burden among older cancer survivors in the United States. Cancer Epidemiol Biomarkers Prev. 2016;25(7):1029-1036.
• 10. Barbera L, Taylor C, Dudgeon D. Why do patients with cancer visit the emergency department near the end of life? Can Med Assoc J 2010; 182(6):563-8.
• 11. Guddati AK, Kumar N, Segon A, et al. Identifying oncological emergencies. Med Oncol 2013;30:669-75.
• 12. Mayer DK, Travers D, Wyss A, Leak A, Waller A. Why do patients with cancer visit emergency departments? Results of a 2008 population study in North Carolina. J Clin Oncol 2011;29(19):2683-8.
• 13. Rivera DR, Gallicchio L, Brown J, Liu B, Kyriacou DN, Shelburne N.Trends in Adult Cancer-Related Emergency Department Utilization: An Analysis of Data From the Nationwide Emergency Department Sample. JAMA Oncol. 2017 Oct 12; 3(10):e172450.
• 14. Grewal K, Rinku Sutradhar R, Krzyzanowska MK, Redelmeier DA, Atzema CL. The association of continuity of care and cancer centre affiliation with outcomes among patients with cancer who require emergency department care CMAJ . 2019 Nisan 23; 191 (16): E436-E445. doi: 10.1503 / cmaj.180962.
• 15. Bonica JJ. Treatment of cancer pain: current status and future need, Vol. 9. New York: Raven Press; 1985.
• 16. Posternak V, Dunn LB, Dhruva A, Paul SM, Luce J, Mastick J et al. Differences in Demographic, Clinical, and Symptom Characteristics and Quality of Life Outcomes Among Oncology Patients with Different Types of Pain. Pain. 2016 Apr; 157(4): 892–900.
• 17. Greco MT, Roberto A, Corli O, Deandrea S, Bandieri E, Cavuto S, Apolone G.Quality of cancer pain management: an update of a systematic review of undertreatment of patients with cancer. J Clin Oncol. 2014 Dec 20; 32(36):4149-54.
• 18. Fallon M , Giusti R , Aielli F, Hoskin P, R. Rolke R, Sharma M, Ripamonti CI , on behalf of the ESMO Guidelines Committee* Management of cancer pain in adult patients: ESMO Clinical Practice Guidelines. Annals of Oncology 29 (Supplement 4): iv166–iv191, 2018 doi:10.1093/annonc/mdy152.
• 19. Neufeld NJ, Elnahal SM, Alvarez RH.Cancer pain: a review of epidemiology, clinical quality and value impact.Future Oncol. 2017 Apr;13(9):833-841.
• 20. Swenson K, Rose MA, Ritz L, Murray C, Adlis S. Recognition and evaluation of oncology-related symptoms in the emergency department. Ann Emerg Med 1995;26: 12-7.
• 21. Brookoff D. The cancer patient in the emergency department.The clinical practice of emergency medicine. 2nd ed. Philadelphia,Lippincott-Raven, 1996:922-8.
• 22. Kocak S, Ertekin B, Polat M, Girisgin S, Kara H.Reasons For Oncology Patients In The Emergency Department Application. Sakaryamj 2012;2(1):16-20.
• 23. Aksu G, Dolaşık I, Ensaroğlu F, Sener SY, Aydın FH, Temiz S, Canoglu D, Uygun K. Evaluation of the Efficacy of Aprepitant on the Prevention of Chemotherapy-Induced Nausea and Vomiting and Quality of Life with Functional Living Index Emesis. Balkan Med J. 2013 Mar; 30(1): 64–67.
• 24. Yaylacı S, Topuzoglu A, Karcıoglu O. Acil Servise Başvuran Kanser Hastalarının Klinik Karakteristikleri ve Bir Yıllık Sağ kalımları. Int J Hematol Oncol 2009;19:4.
• 25. Caterino JM, Adler D, Durham DD, Yeung SJ, Hudson MF, Bastani A et al. Analysis of Diagnoses, Symptoms, Medications, and Admissions Among Patients With Cancer Presenting to Emergency Departments. JAMA Netw Open. 2019 Mar 1; 2(3):e190979.