CLINICAL CHARACTERISTICS, OUTCOME AND ITS ASSOCIATED FACTORS AMONG ADULT ONCOLOGICAL PATIENTS PRESENTING TO EMERGENCY DEPARTMENT OF TERTIARY HOSPITAL IN TANZANIA

Abstract

Background: The worldwide burden of cancer is predicted to rise, especially in developing nations. Patients with cancer have a significant risk of developing life-threatening complications and are becoming a larger part of the population presenting to the Emergency Department. Recent information on the primary complaints, clinical presentations, and outcomes of Emergency Department visits by cancer patients in low-middle income countries is scarce. 

Objective: To determine clinical characteristics, outcomes, and associated factors associated with hospital mortality among adult oncological patients presenting to the emergency department of a tertiary hospital in Tanzania.

Methodology: A prospective cohort study was conducted from November 2023 to January 2024 at the Emergency Department at Muhimbili National Hospital. Patients were included if they had a previously diagnosed oncological disease and consented to participation. Demographic data, chief complaint, clinical characteristics, laboratory investigations, management at emergency department,National Early Warning Score was calculated retrospectively from initial vital signs (low score 1–4, medium 5–6, high score ≥7; RED score = extreme variation (3 points) in a single physiological parameter). Patients were followed in the hospital until discharge or death for 7 days. The primary outcome was 24-hour mortality, and the secondary outcome was 7 days mortality. Univariate and multivariate analysis was used to determine the association between patient and disease characteristics and mortality at 7 days.

 Results: During the study period, 239 oncological patients were enrolled (2.7% of all visits); three were lost to follow-up, leaving 236 for analysis. representing 2.4% (95% CI 2.1 – 2.7) of emergency department visits. The mean (±SD) age was 55 ± (14) years, 56.4% were female, 34% had at least one comorbidity and 47.5% had ECOG status of 3 and above. The most common cancers were the esophagus (24.6%), cervical (17.4%), and breast (11.9%). 47.% had an ECOG status of 3 or greater and 50% were anemic.  At 24 hours, 13 patients (5.5%) had died; at 7 days, a total of 31 patients (13.1%; 95% CI 9.1-18.1) had died. Univariate analysis revealed that patients with a comorbidity (cOR 2.19; 95% CI 1.03-4.65 p 0.042), National Early Warning Score - RED (cOR 2.76, 95% CI 1.24-6.13 p0.012) and Poor ECOG Status > 2 (cOR 7.28; 95% CI 3.17-16.73 p<0.001 had higher odds of mortality within 7 days. Age, sex, time of arrival at the emergency department, and tumor location were not associated with 7-day mortality. In multivariate analysis, RED National Early Warning Score was independently associated with mortality within 7 days (aOR 5.90 95% CI: 2.49-13.94, p<0.001.)

Conclusion: Cancer patients account for at least 2.7% of all visits to the emergency department. They present in advanced stages of disease with significant laboratory abnormalities. Notably esophageal cancer was the most common, suggesting an overlooked disease in our setting. The prevalence of cervical cancer suggests the need for more widespread screening. While ECOG status and comorbidity were associated with mortality in univariate analysis, only a RED National Early Warning Score was found to be an independent predictor of hospital mortality.