Oncologic emergencies and urgencies: A comprehensive review.

Area of Science:

• Oncology
• Emergency Medicine
• Palliative Care

Background:

• Advanced cancer patients account for 4 million annual emergency department (ED) visits.
• Increasingly complex cancer treatments and a growing geriatric population lead to frail, acutely ill patients.
• Acute decompensations in cancer patients require specialized urgent care.

Purpose of the Study:

• To comprehensively review oncologic emergencies and urgencies in acute care settings.
• To discuss presentation, etiology, and clinical pathways for managing these conditions.
• To provide guidance on safe discharge or inpatient transition of care.

Main Methods:

• Literature review of oncologic emergencies and urgencies.
• Discussion of common and less familiar conditions.
• Summary of complications from novel cancer therapeutics.

Main Results:

• Covers a broad spectrum of oncologic emergencies, including febrile neutropenia, hypercalcemia, tumor lysis syndrome, spinal cord compression, bowel obstruction, and pain crises.
• Includes less common emergencies like SIADH, VTE, malignant effusions, and chemotherapy toxicities (mucositis, cardiomyopathy, GI upset).
• Summarizes emergent complications of targeted therapies, monoclonal antibodies, ICIs, and CAR T-cells.

Conclusions:

• Provides a point-of-care reference for ED physicians, outpatient oncologists, and inpatient hospitalists.
• Emphasizes criteria for safe discharge or inpatient transfer.
• Discusses strategies for hospice admission directly from the ED.