Volume and acuity trends in geriatric patients with cancer: Insights from a comprehensive cancer center.

Abstract

e13852 Background: The risk of cancer increases with age, and with the continuous advancement of the use of novel cancer therapies and improved survival outcomes of cancer patients, the number of geriatric cancer patients is projected to rise. In 2020, of the 19.3 million new cancer cases worldwide, 64% occurred in individuals aged 60 and above, contributing to 71.3% of cancer-related deaths. Our study examined the trends in the volume and acuity of geriatric patients presenting to an oncologic emergency department (ED). Methods: All consecutive patients who presented to the ED at The University of Texas MD Anderson Cancer Center between January 1, 2018, and December 31, 2023, were identified using data from the institution's warehouse. Age at the time of visit was used to categorize the patients into geriatric (≥65 years) and non-geriatric ( < 65 years) age groups. Descriptive statistics were used to summarize the main characteristics and acuity of the geriatric group. The Cochran-Armitage test was used to assess the trend in the volume and acuity (based on the Emergency Severity Index [ESI] 5 levels) of geriatric patients presenting to the ED over the study period. Results: A total of 165,616 ED visits occurred during the study period, of which 40.9% (n = 67,678) visits were patients ≥65 years old, representing 29,591 unique geriatric patients. The median age for these unique patients at the time of their ED visit was 72 years (interquartile range = 68–77 years). Most patients were White/Caucasian (76.0 %) or Black/African American (11.2%). Emergent (31.0%) and urgent (66.2%) acuity levels (i.e., ESI levels 2 and 3 respectively) accounted for the majority of the geriatric ED visits. The number of ED visits by geriatric patients showed a significant upward trend (P < 0.001), increasing from 39.2% in 2018 to 43.0% in 2023. In addition, these ED visits demonstrated a significant increase (P < 0.001) in acuity level, as the proportion of emergent cases (ESI level 2) grew from 19.3% in 2018 to 38.6% in 2023, and the urgent cases (ESI level 3) decreased from 76.8% in 2018 to 59.2% in 2023. Conclusions: In this study we observed a growing trend in oncologic ED visits by patients 65 and older, along with a rise in the acuity level of these visits. As aging trends within the cancer population are expected, tailored healthcare approaches for geriatric cancer patients in the ED are essential to address the unique and changing needs of this population.