"Triple Threat" Conditions Predict Mortality Among Patients With Advanced Cancer Who Present to the Emergency...

Area of Science:

• Oncology
• Emergency Medicine
• Palliative Care

Background:

• Delirium, poor performance status, and dyspnea are known predictors of short survival in palliative care.
• These symptoms, termed a "triple threat," were investigated for their prognostic value in advanced cancer patients in the emergency department (ED).

Purpose of the Study:

• To determine if the "triple threat" of delirium, poor performance status, and dyspnea predicts mortality in advanced cancer patients presenting to the ED.
• To assess the association between the number of "triple threat" symptoms and 30-day mortality.

Main Methods:

• A study of 243 clinically stable advanced cancer patients presenting to the ED.
• Inclusion criteria: delirium (Memorial Delirium Assessment Scale score ≥ 7), poor performance status (ECOG 3 or 4), or dyspnea.
• Logistic regression analysis was used to calculate the predicted probability of 30-day mortality.

Main Results:

• Twenty-eight patients (11.5%) died within 30 days.
• 30-day mortality was 36% for delirium, 28% for poor performance status, and 14% for dyspnea.
• Patients with two or three "triple threat" conditions had a 49% predicted probability of 30-day mortality, compared to 5% for those with none or one.

Conclusions:

• Advanced cancer patients in the ED with at least two "triple threat" conditions (delirium, poor performance status, dyspnea) have a significantly high probability of death within 30 days.
• The "triple threat" model effectively predicts short-term mortality in this population.