Knox H. Todd Charles R. Thomas, Jr. Editors Oncologic Emergency Medicine Principles and Practice 123 Oncologic Emergency Medicine Knox H. Todd • Charles R. Thomas, Jr. Editors Oncologic Emergency Medicine Principles and Practice Associate Editors: Steven L. Bernstein, Tammie E. Quest, Sai-Ching Jim Yeung Editors Knox H. Todd , MD, MPH Charles R. Thomas, Jr., MD Founding Chair Professor and Chair Department of Emergency Medicine Department of Radiation Medicine The University of Texas MD Anderson Knight Cancer Institute Cancer Center Physician-in-Chief, Radiation Oncology Service Houston, TX , USA OHSU Healthcare Oregon Health and Science University Portland , OR , USA ISBN 978-3-319-26385-4 ISBN 978-3-319-26387-8 (eBook) DOI 10.1007/978-3-319-26387-8 Library of Congress Control Number: 2016940519 © Springer International Publishing Switzerland 2016 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifi cally the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfi lms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. T he use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specifi c statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. Printed on acid-free paper This Springer imprint is published by Springer Nature The registered company is Springer International Publishing AG Switzerland This book is dedicated to my wife, Courtenay Carmody, and my two sons, Samuel and Benjamin, whose love and support bring great joy to my life and purpose to my work. In memory of my mother, Mary Kate Todd, who left us much too early. –KHT To my supportive wife, Muriel Elleen; our wonderful two children, Julian Franklin and Aurielle Marie; our parents; and siblings for their love and support of my career path. In memory of my mother, Ruth Marie Wilson Thomas, who fought gallantly in the war against cancer and whose prayers have blessed me over the past fi ve decades. –CRT Foreword If you or members of your healthcare team ever have questions about the best, most current evaluation and management plans for patients with just about any oncologic emergency, Oncologic Emergency Medicine: Principles and Practice is your answer. This text is written with the clinical provider continuum in mind, so important in modernized oncology practice. We are privileged to write this foreword to such a needed resource. Oncologic Emergency Medicine is an important and rapidly evolving area of clinical collaboration among groups of providers who desire together to take the very best care of their shared patients. No longer should those with cancer enter the emergency department without some certainty about what will likely transpire and that they will receive care that is closely coordinated between emer- gency care providers and the oncology team. O ne overarching theme in this fi rst comprehensive text dedicated to the best, personalized, patient centric clinical care is enhanced communications. We believe the best and most effec- tive clinical care is derived from establishing communication standards prior to any emer- gency department (ED) encounter. This may include pre-ED communication (EHR, email, texting, phone calls, etc.), appropriate time frames for responses, appropriate physical space, coordinated evaluation plans, and transparent communications among various members of the emergency oncology team to achieve optimal results. The complexities of personalized oncol- ogy care require advance preparation, mutual goal setting among the patient and family, as well as the emergency and oncology clinical teams. This text is written by distinguished experts from a large, multidisciplinary pool and is focused on the cancer survivor, from incipient diagnosis through therapy and its complica- tions, including appropriate measures to control pain and distress, involving attention to supe- rior palliative care. The publication of this text is critically timed given the very recent engagement of the National Cancer Institute (NCI) in moving forward with descriptive studies of cancer patients presenting to US emergency departments. Specifi cally, the NCI is sponsor- ing the creation of the Comprehensive ONCologic Emergencies Research Network (CONCERN), a research consortium to begin to address important research needs among emergency department patients with cancer ( h ttp://epi.grants.cancer.gov/Consortia/single/ concern.html ) . T his text should be on the bookshelf (or on the wireless network, compact disk, MP3, or all) of all who provide cutting-edge diagnosis and management to those with oncologic emer- gencies. The editors and authors are communicating a message of hope to those with cancer by supporting the development of personalized oncologic emergency care for each human, based upon their needs, and applying the latest knowledge to optimize care for individual patients, their disease, and their unique circumstances. Of the more than 136 million encoun- ters and growing in US emergency departments, larger proportions are likely to present with vii viii Foreword an oncologic emergency. Excellent communications among multiple disciplines are essential to optimal care for those with cancer. This foundational text represents a critical addition to this conversation. Columbus, OH, USA Richard M. Goldberg Thomas E. Terndrup Pref ace I t is with great excitement that we present the fi rst edition of Oncologic Emergency Medicine: Principles and Practice . Against the backdrop of rising numbers of cancer patients and survi- vors as the US population ages and a forecast shortage of cancer care providers, this book is designed to serve as the fi rst authoritative, single-source clinical reference on oncologic emer- gencies. This comprehensive text was specifi cally designed to address the complexities of understanding and managing cancer emergencies with an emphasis on increasing communica- tion and collaboration between emergency physicians and the multiple providers who partici- pate in caring for those with cancer. The contributors include a broad spectrum of experts in emergency medicine, surgical and medical oncology, hematology, diagnostic and interventional radiology, palliative care, psy- chiatry, critical care, dermatology, ophthalmology, clinical pharmacy, addiction psychology, and health services research (including epidemiology, outcome disparities, health economics, and bioethics). Emergency departments account for approximately one-half of all hospital admissions, and this proportion is likely higher for those with cancer. While the largest portion of the book focuses on a number of clinical oncologic emergencies and their varied presentations to the emergency department, this text offers the opportunity to address more broadly and systemati- cally the vantage point of emergency physicians who work in a critical hub of patient care: the emergency department. Emergency department visits resulting from disease progression as well as toxicities of anticancer treatments serve as a patient-oriented metric of cancer care quality. This text emphasizes the critical importance of emergency department care within a comprehensive cancer treatment system. The principles of care will be similar whether the emergency department is in a dedicated clinical cancer care facility or a matrix care structure. The methods of executing best practices may differ based on the structure of the cancer care system; however, the vast majority of emergency care for those with cancer is similar across emergency department settings, whether in academic or community settings. The text is structured to cover four fundamental areas of emergency care: P art I is centered on systems and contextual issues surrounding the emergency department. We discuss existing models of emergency department care, the evolving role of quality mea- sures for oncologic emergency medicine, ethics of care, rapid healthcare learning systems, and the important roles of emergency department social workers and patient navigators. P art II, capably edited by Steven Bernstein, considers the role of emergency medicine in primary and secondary cancer prevention, including smoking cessation, cervical cancer pre- vention and detection, ionizing radiation exposure, as well as a discussion of radio terrorism. Part III will seem perhaps the most familiar to readers and includes considerations of a variety of oncologic emergencies, organized by organ systems, cancer type, and treatment- related toxicities. We appreciate the work of our associate editor, Jim Yeung, in editing this section. Part IV, edited with the assistance of Tammie Quest, examines important issues related to the end of life care, including the role of palliative surgery, the management of symptoms in those with advanced cancer, approaches to opioid analgesic use (and misuse), as well as the ix