One afternoon a few weeks ago, Faithe Craig noticed that her temperature had spiked to just above 100 degrees. For most people, that might not be cause for alarm, but Craig is being treated for Stage 3 breast cancer, and any temperature change could signal a serious problem.
She called the University of Texas Southwestern Medical Center. Her nurse there told her to come in immediately for urgent-care services at the hematology oncology clinic.
“I thought I’d be waiting there all night,” said Craig, 33. But the clinic had lined up a blood draw before she arrived and then sent her directly to get X-rays.
Clinicians had details of her case at their fingertips. “They already knew my story and knew everything about me,” she said. The bloodwork showed she had severe anemia and required a blood transfusion, pronto.
It has been more than a year since the Dallas medical center began providing same-day urgent-care services to cancer patients. It’s an effort to help them avoid the emergency department and admission to the hospital, said Thomas Froehlich, medical director of all the center’s cancer clinics.
Cancer treatment “clearly carries a lot of side effects and toxicity, and there are also complications of dealing with the cancer,” Froehlich said. “Many of these things, if you can intervene early, you keep patients at home and out of the hospital.”
A small but growing number of hospitals and oncology practices are offering cancer patients urgent care in which specialists are available, often for extended hours and sometimes around the clock.
Keeping cancer patients out of the emergency department makes sense not only because many of them have compromised immune systems that put them at risk in a waiting room full of sick people, but also to provide the most efficient and appropriate care.
“What we hear from cancer physicians and administrators is that in the emergency department not all emergency physicians and nurses feel equally confident in their ability to treat cancer patients,” said Lindsay Conway, managing director of research at the Advisory Board, a health-care research and consulting firm. “So they may admit them [to the hospital as inpatients] when it’s not necessary.”
Severe pain, nausea, fever and dehydration are not uncommon side effects of traditional chemotherapy. Newer immunotherapy treatments that activate the immune system to fight cancer can cause serious and sudden reactions if the immune system instead attacks healthy organs and tissues.
It can be difficult for physicians who are not cancer specialists to evaluate what these symptoms mean. “Targeted therapies are wonderful, but if you don’t know the drug, you’re going to have a hard time managing the person,” said Barbara McAneny, chief executive of New Mexico Oncology Hematology Consultants, whose three centers around the state provide urgent care for more than a dozen cancer patients daily.
Offering same-day services fits in with a broader shift in oncology toward patient-centered care, said J. Leonard Lichtenfeld, deputy chief medical officer at the American Cancer Society.
“There’s a general sense within the practice of oncology that we need to do a better job of managing pain and side effects, and we need to provide a higher level of care,” Lichtenfeld said.
The federal Centers for Medicare & Medicaid Services is encouraging these efforts through new payment and delivery models, Lichtenfeld said. And starting in 2020, hospitals may be penalized financially if outpatient chemotherapy patients visit the emergency department or are admitted to the hospital, according to a final rule issued in November.
Avoiding the emergency department makes financial sense for patients and insurers, too.
Johns Hopkins Hospital opened a six-bed urgent-care center next to its chemotherapy infusion center a couple of years ago. Of the patients who land there, about 80 percent are discharged home, at an average total hospital charge of $1,600, said Sharon Krumm, director of nursing at Johns Hopkins Kimmel Cancer Center. (The patient and the insurer would divvy up that charge based on the patient’s insurance coverage.) Only 20 percent of cancer patients who visit the hospital’s emergency department are discharged home, with an average total hospital charge of $2,300. The others face the ER charges plus the hefty cost of a hospital admission.
Rebecca Cohen has been a frequent visitor to the Johns Hopkins urgent-care center. Diagnosed more than two years ago with Stage 4 lung cancer, Cohen, 68, is receiving immunotherapy. She has been treated or checked for dehydration, electrolyte abnormalities, low hemoglobin, low sodium, blood clots and infection, among other things.
Before she started going to the cancer urgent-care center, “you sat in the waiting room at the emergency room with people who had the most extraordinary diseases,” Cohen said. “Having Stage 4 lung cancer, the thought of being exposed to pneumonia or bronchitis is more than scary.”
This column is produced by Kaiser Health News. KHN, an editorially independent news service and is a program of the Kaiser Family Foundation.