Epidemiology, clinical profile, and outcomes of older patients with active cancer attending at Spanish emergency departments (EDEN-56 study).

Background

Older adults with active cancer are increasing, clinically complex emergency department (ED) population, but large multicenter European data are limited.

Objective

To describe the epidemiology, baseline characteristics, diagnoses, and outcomes of older patients with active cancer attending Spanish EDs, and assess whether associations between active cancer and short-term outcomes varied with age and sex.

Design, setting, and participants

Secondary analysis of the Emergency Department and Elder Needs retrospective multicenter registry, including all patients aged greater than or equal to 65 years attending 52 Spanish EDs during 1-7 April 2019. Patients with and without active cancer were compared. Annualized incidence was extrapolated overall, by sex, and by age. Age-related patterns were modeled using restricted cubic splines.

Outcome and analysis

ED length of stay, hospitalization, length of hospitalization, and index-episode death. Age-by-cancer and age-by-sex interactions were assessed in unadjusted and multivariable models.

Main results

Among 25 557 older ED patients, 4701 (18.4%) had active cancer. The estimated annualized incidence of ED presentations was 10 885 per 100 000 inhabitants aged greater than or equal to 65 years [95% confidence interval (CI): 10 576-11 200], higher in men (annualized rate ratio: 1.80, 95% CI: 1.70-1.91) and in the mid-to-late 80s. Patients with cancer had more severe comorbidity (58.9 vs. 12.9%), polypharmacy (26.6 vs. 21.3%), and walking handicaps (31.5 vs. 28.2%). Malignancy accounted for only 7.7% of ED diagnoses in the cancer group; infections, heart failure, and respiratory conditions were frequent. Active cancer was associated with longer median ED stay (4.0 vs. 3.3 h; adjusted difference: 0.3, 95% CI: 0.1-0.4), higher hospitalization [32.5 vs. 24.0%; adjusted odds ratio (OR): 1.34, 95% CI: 1.25-1.44], longer median hospitalization (7.5 vs. 6.9 days; adjusted difference: 0.5, 0.1-0.9), and higher index-episode mortality (5.5 vs. 2.5%; adjusted OR: 2.12, 95% CI: 1.81-2.50). Age significantly modified ED length of stay, hospitalization, and mortality, with significantly different age-related changes between patients with and without cancer. Among patients with cancer, age-related trajectories did not significantly differ by sex.

Conclusion

Active cancer is common among older ED patients and associated with substantial resource use and worse short-term outcomes. These associations vary with age, supporting multidimensional assessment beyond chronological age or cancer status alone.