Managing Patients with Oncologic Complications in the Emergency Department -
Publication Date: January 2018 (Volume 20, Number 1)
David Wacker, MD
Assistant Professor; Section of Pulmonology, Allergy, Critical Care, and Sleep Medicine; Department of Internal Medicine; University of Minnesota Medical School, Minneapolis, MN
Michael T. McCurdy, MD
Associate Professor, Pulmonary & Critical Care Medicine; Associate Professor of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD
Karin Chase, MD
Assistant Professor of Medicine and Emergency Medicine, Departments of Medicine and Emergency Medicine, University of Rochester Medical Center, Rochester, NY
Natalie Kreitzer, MD
Assistant Professor, Emergency Medicine and Neurocritical Care, University of Cincinnati, Cincinnati, OH
As the prevalence of cancer continues to increase in the general population and improvements in cancer treatment prolong survival, the incidence of patients presenting to the emergency department with oncologic complications will, similarly, continue to rise. This issue reviews 3 of the more common presentations of oncology patients to the emergency department: metastatic spinal cord compression, tumor lysis syndrome, and febrile neutropenia. Signs and symptoms of these conditions can be varied and nonspecific, and may be related to the malignancy itself or to an adverse effect of the cancer treatment. Timely evidence-based decisions in the emergency department regarding diagnostic testing, medications, and arrangement of disposition and oncology follow-up can significantly improve a cancer patient's quality of life.
Excerpt From This Issue
A 67-year-old man presents to the ED with a 5-day history of constant, dull, nonradiating, mid-lower back pain. He denies any alleviating factors or any specific movements or ambulation that worsen the pain. He denies numbness or weakness to his lower extremities, fevers, or bowel or bladder problems. His past medical history is significant for low-grade prostate cancer, diagnosed 2 years ago, which was managed by active surveillance only. On exam, his strength to both lower extremities seems diminished, his patellar reflexes are brisk, and his gait is unstable. He has no range-of-motion limitations to his back, but does complain of some midline tenderness at about the L1 level. Straight-leg raise is negative on both sides. His rectal tone is normal. At the conclusion of his exam, he states: “I really just came in to get something for the pain, doc. Can you prescribe me something so I can get going?” You wonder if he needs more testing...
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