BACKGROUND and AIM: The AIRTUM registry documented approximately 80,000

new urogenital tumors diagnosed in 2014 in Italy 1. Moreover,the availability of new

therapeutic strategies makes the treatment process more complex and considerably
increases the risk of toxicities and complications. As a result , more cancer outpatients
may ask for unplanned visits in oncology clinic 2. Accordingly, a large retrospective
study showed that prostate cancer is the fourth most common tumor in patients
admitted to Emergency departments in the United States 3. Our study aims to describe
the magnitude of unscheduled visit of urological cancer patients and to identify risk
factors for repeated unplanned presentations and hospitalization.
PATIENTS and METHODS: From October 1st 2006 to September 30th 2008, 1,431
cancer patients accessed to our acute oncology clinic and 2,811 unplanned
consultations were reviewed over this 2-year period. We focused our analysis on the
113 subjects with a diagnosis of urological cancer (205 total unplanned consultations).
Baseline demographic data (age, gender, and Karnofsky performance status [KPS])
and clinical variables (primary cancer site, type of chemotherapy regimen, and
treatment setting) were all recorded together with reasons for presentation, laboratory
values, and outcome of the visit. Cross-tables, test, and Logistic Regression were
used to evaluate the relation of potential predictors for the two outcome events:
repeated presentations and hospitalization. The study was approved by the
Investigational Review Board.
RESULTS: Among our 113 consecutive patients, 32 (28.3%) were diagnosed with
prostate cancer, 48 (42.5%) with renal cell cancer, 19 (16.8%) with bladder cancer, 9
(7.9%) with testicular cancer, and 5 (4.4%) with other transitional cell cancers. Overall,
60 patients (53.1%) received chemotherapy and 17 (15.0%) received endocrine
treatment during the 90 days before the unplanned consultation. The median KPS at
the time of the unscheduled presentation was 70% and the median age was 69.1
years (range 25.5 to 87.7). More than 85% of patients were male (98 men versus 15
women).
Pain (38.5%), fatigue (20.5%), hematological disorders such as anemia, neutropenia,
or thrombocytopenia (16.6%), dyspnea (11.7%), cachexia (11.2%), and fever (9.3%)
were frequently reported; 50.2% of patients had more than 1 reason for the unplanned
visit (table 1).
In this cohort, 47 patients (41.6%) had repeated unplanned presentations and 14
consultations (6.8%) led to hospital admission. According to univariate analysis, pain
(P=0.009), dyspnea (P<0.001), pleural effusion/ascites (P<0.001), cachexia (P<0.001),

neurological disorders (P=0.036), and multiple reasons for unscheduled visit (P<0.001)
were signs/symptoms related with higher risk of hospitalization (table 2). In
multivariate analysis only dyspnea (P<0.001) and cachexia (P=0.016) were significant
predictor of hospitalization (table 2). Similarly, pain (P=0.048), hematological
disorders (P<0.001), cachexia (P=0.037), chemotherapy administered within 90 days
(P<0.001), and multiple complaints (P=0.003) were signs/symptoms related with
repeated unscheduled consultations (table 3). In multivariate analysis only cachexia
(P=0.003) and chemotherapy administered within 90 days (P=0.048) were significant
predictor of multiple unscheduled visits (table 3).
CONCLUSIONS: Urogenital cancer outpatients may frequently ask for unplanned
care, with pain still being the most frequent reason. The optimal management of these
unscheduled presentations is becoming crucial in order to improve quality of oncology
services as well as patients quality of life. A more correct approach would also reduce
both interferences with the ordinary work and inappropriate hospital admissions. An
updated analysis on a longer period is ongoing and will be soon available.
REFERENCES
1. http://www.registri-tumori.it/PDF/AIOM2014/I_numeri_del_cancro_2014.pdf

Accessed

on December 20th 2014.

2. Aprile G, et al. Unplanned presentations of cancer outpatients: a retrospective cohort
study. Support Care Cancer. 2013;21:397-404.
3. Mayer DK, et al. Why do patients with cancer visit emergency departments? Results of
a 2008 population study in North Carolina. J ClinOncol. 2011;29:2683-2688.