Another Hospital Admission Through The Emergency Room? Looking For A Fragility Pattern In Advanced Cancer Patients.

65 Background: Cancer patients (pts) are often treated with anticancer therapy (CT) even in the last months of life and are often hospitalized through an access to the emergency room (ERa). This is frequently the time when a palliative care (PC) service starts, or when pts die. Methods: We performed a retrospective analysis of pts admitted to our Oncology Unit through an ERa. We evaluated: pts’ characteristics, histology, date of diagnosis, sites of metastases, comorbidities, previous CT and radiotherapy (RT), imaging procedures and other exams in the last 90 days (90d), previous ERa and admissions for supportive care (SC), including transfusions, parenteral/enteral nutrition, high-cost antibiotics, in the last 90d. Pts were divided into 2 fragility groups: less fragile (LF), candidate after discharge to further CT or follow-up, and more fragile (MF), pts candidate to PC or who died in the Oncology Unit. Results: From August 2017 to May 2018 441/756 pts (58.3%) were admitted through an ERa: women/men 219/222, median age 65.4 years (y), range (r) 18.9 - 89.7. 328 pts had visceral metastases, 287 pts had ≥1 comorbidity, 318 pts received ≥1 line of CT (r 1-8), 121 pts received ≥1 RT (r 1-5), 240 pts had ≥1 prior admission for SC (r 1-6), 224 pts had an ERa (r 1-6) and 141 pts had ≥1 hospitalization for SC (r 1-4) in the last 90d, 386 pts received ≥1 diagnostic exam in the last 90d (r 1-12). Pts were grouped as follows: LF/MF 236/205. Differences between the 2 groups were: pts ≥70 y 31% in LF, 40% in MF, p=0.047; visceral metastases 70.1% in LF, 85.1% in MF, p<0.001; ≥1 line of CT 64% in LF, 81% in MF, p<0.001; ≥1 RT 23% in LF, 32% in MF, p=0.036; admissions for SC 47% in LF, 62.9% in MF, p<0.001; ERa in the last 90d 39% in LF, 64% in MF, p<0.001; admissions for SC in the last 90d 24.4% in LF, 39.4% in MF, p=0.004. No other differences were observed between the 2 groups. Conclusions: We identified a MF profile: pts ≥70 y, with visceral metastases, ≥1 line of CT and ≥1 RT course for advanced disease, ≥1 prior hospitalization for SC, ≥1 ERa and ≥1 admission for SC in the last 90d. The identification of this fragility profile may help oncologists timely offer a PC program to advanced stage pts. This could prevent some ERa and hospital admissions close to the end of life.