On an afternoon a few weeks ago, Faithe Craig noticed that her temperature spiked to just above 100 degrees. For most people, the change 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 her nurse at the hospital clinic where she gets care at the University of Texas Southwestern Medical Center in Dallas, who told her to come in immediately for cancer urgent-care services at the hospital鈥檚 hematology oncology clinic.
鈥淚 thought I鈥檇 be waiting there all night,鈥� said Craig, 33.聽But the hospital had already lined up a blood draw before she arrived and then sent her directly聽to get X-rays.
Clinicians had details of her cancer care at their fingertips. 鈥淭hey already knew my story and knew everything about me,鈥� she said. The blood work showed she had severe anemia, requiring a blood transfusion, pronto.
It鈥檚 been more than聽a year since the medical center began providing same-day urgent care services to cancer patients. It鈥檚聽an effort to help them avoid the emergency department and hospital admissions, said Dr. Thomas Froehlich, medical director of the all the center鈥檚 cancer clinics.
Cancer treatment聽鈥渃learly carries a lot of side effects and toxicity, and there are also complications of dealing with the cancer,鈥� Froehlich said. 鈥淢any of these things, if you can intervene early, you keep patients at home and out of the hospital.鈥�
UT Southwestern isn鈥檛 alone. A small but growing number of hospitals and oncology practices are aimed specifically at cancer patients, in which聽specialists are available for same-day appointments, often with extended hours, sometimes 24/7.
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 to provide the most efficient and appropriate care.
Faithe Craig, who is being treated for stage 3 breast cancer, recently sought urgent care services at the University of Texas-Southwestern Medical Center in Dallas. (Courtesy of Faithe Craig)
鈥淲hat 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,鈥� said Lindsay Conway, managing director of research at the Advisory Board, a health care research and consulting firm. 鈥淪o they may admit them when it鈥檚 not necessary.鈥�
Severe pain, nausea, fever and dehydration are not uncommon side effects of traditional chemotherapy. Newer that activate the immune system to fight cancer聽can cause serious and sudden reactions if the body instead attacks healthy organs and聽tissues.
It can be difficult for non-cancer specialists to evaluate what these symptoms mean. 鈥淭argeted therapies are wonderful, but if you don鈥檛 know the drug, you鈥檙e going to have a hard time managing the person,鈥� said Dr. Barbara McAneny, CEO of New Mexico Oncology Hematology Consultants in Albuquerque, which operates three cancer centers in New Mexico that together provide same-day urgent care services for more than a聽dozen cancer patients daily.
Offering same-day services聽fits in with a broader shift in oncology toward patient-centered care, said Dr. J. Leonard Lichtenfeld, deputy chief medical officer at the American Cancer Society.
鈥淭here鈥檚 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,鈥� Lichtenfeld said.
The federal Centers for Medicare & Medicaid Services is encouraging these efforts through designed to reward quality cancer care, Lichtenfeld said.聽In addition, starting in 2020 hospitals may be penalized financially if patients who are receiving outpatient chemotherapy visit the emergency department or are admitted to the hospital, according to a .
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 infusion center a couple of years ago.聽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鈥檚 insurance coverage.) Only 20 percent of cancer patients who visit the hospital鈥檚 emergency department are discharged home. Those who are have 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.聽She鈥檚 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, 鈥測ou sat in the waiting room at the emergency room with people who had the most extraordinary diseases,鈥� Cohen said. 鈥淗aving stage 4 lung cancer, the thought of being exposed to pneumonia or bronchitis is more than scary.鈥�
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