Cancer Patients: Hospital Access, Symptoms & Emergency Care in Italy

Nearly 3.7 million Italians have received a cancer diagnosis, representing more than six in one hundred citizens. A significant proportion of those with advanced cancer experience at least one unplanned hospital admission during their illness. These admissions are driven by cancer-related symptoms, acute events like infections or thrombosis, or side effects of treatment. This trend is expected to continue for several reasons: a growing number of cancer diagnoses, increasing survival rates leading to longer treatment durations and a predominantly aging population, often with pre-existing health conditions.

More than half of cancer patients who present to the Emergency Department (ED) require hospitalization, often for a longer duration than non-oncological patients. This situation highlights several urgent challenges, including bed availability, staffing levels of specialized medical and nursing personnel, and the need for dedicated pathways to streamline hospital access for cancer patients.

The Reasons for Urgent Access: Symptoms

A recent report by the Italian Federation of Associations of Volunteer Oncology (Favo) sheds light on the situation in Italy. The report, coordinated by the Italian Network of Supportive Care in Oncology (Nicso) in collaboration with the Italian Association of Medical Oncology (Aiom) and the Italian College of Hospital Oncology Directors (Cipomo), identifies symptoms as the most common reason for hospital access, accounting for approximately 50% of cases. These include pain, jaundice, shortness of breath (particularly in cases of lung cancer or metastases), neurological symptoms, and intestinal obstruction. “These symptoms often require not only targeted symptom relief but also specific cancer treatment, such as medication or radiotherapy,” explains Gianmauro Numico, Director of Medical Oncology at Azienda Ospedaliera S. Croce e Carle of Cuneo and a member of the Nicso board.

Notably, around 25-30% of cancer diagnoses occur during a hospital admission due to acute symptoms, meaning that over a quarter of cancer diagnoses are now made through an ED visit.

The Reasons for Urgent Access: Acute Events and Toxicity

Approximately 30% of cancer patients require emergency care due to acute events not directly related to the cancer itself, such as infections. While the presence of cancer can worsen the prognosis in these cases, the treatment remains consistent with that for non-cancer patients. Around 20% of ED visits are attributable to side effects of cancer therapies, often requiring treatment suspension and specialized supportive care. “Approximately 35% of patients with cancer die in hospital, therefore admission to the ward is frequent even in the end-of-life pathway,” adds Andrea Antonuzzo, Head of Medical Oncology 4, Internal and Geriatric Supportive Care at the Fondazione IRCCS Istituto Nazionale dei Tumori of Milan and a member of the Nicso board.

From Hospital Entry to Admission

Data indicates that 3-10% of individuals presenting to emergency departments have a history of cancer. When a patient has cancer, more than half of urgent accesses result in hospitalization, compared to 10-15% in non-oncological cases. Access to the ED can occur through self-presentation, referral from a general practitioner or specialist, or transfer from other healthcare facilities. “Regardless of the reasons for presentation, statistics show that cancer patients have longer hospital stays, more complex conditions, higher in-hospital mortality rates, and require specific management approaches,” says Monica Giordano, Secretary of Cipomo and Director of the Complex Oncology Structure at Ospedale Sant’Anna of Como.

A critical issue is the availability of hospital beds, which are decreasing both in Italy and across Europe. Between 2012 and 2022, the number of beds decreased by approximately 10% in Europe and 35% in Italy.

Potential Solutions

The Favo report outlines several potential solutions. These include dedicated oncologists and nurses, readily available essential services like laboratory tests and radiology, close integration with the ED to leverage specialized expertise, and the possibility of direct admission (triage within the hospital without going through the ED) in appropriate cases.

Practical Advice if the ED is Necessary

If a visit to the ED is necessary, experts recommend the following:

1. Always carry a list of current medications (both cancer-related and other drugs), and ideally, a recent oncology consultation letter.
2. In an emergency, go to the nearest ED, which may not necessarily be the hospital where you receive your cancer care.
3. If possible, contact your care team or general practitioner before going to the ED to assess the urgency of the situation.
4. Follow the ED physician’s recommendations regarding management and hospitalization.