23 Background: Patients with cancer receiving chemotherapy often present to the ED and require hospitalization to manage acute issues. However, little work has sought to understand characteristics associated with hospitalizations for patients with cancer receiving chemotherapy who present to the ED. Methods: As part of a quality improvement initiative, we reviewed ED visits within 30-days of patients receiving intravenous chemotherapy at Massachusetts General Hospital from October 2017-January 2018. We used descriptive statistics to compare sociodemographic and clinical factors for hospitalized and non-hospitalized patients. We used logistic regression to explore variables independently associated with being hospitalized. We also compared death rates within 6 months between groups. Results: We identified 500 ED visits during our study period, which resulted in 350 (70.0%) hospitalizations. Hospitalized and non-hospitalized patients did not differ by age (mean 64.1 vs 63.4, P = 0.61), sex (48.9% vs 51.3% female, P = 0.61), or presence of metastatic disease (71.1% vs 68.7%, P = 0.59). Hospitalized patients were more likely to have gastrointestinal (25.7% vs 20.7%) and lung (14.0% vs 11.3%) cancer; less likely to have breast cancer (7.4% vs 16.7%, P < 0.01). Hospitalized patients were more likely to come to the ED on a Thursday (15.7% vs 6.7%); less likely to come on a Wednesday (10.3% vs 19.3%, P < 0.01). On logistic regression, factors associated with higher likelihood of being hospitalized included white race (OR = 1.84, P = 0.03), and presenting with fever/cold symptoms (OR = 2.64, P < 0.01), fatigue (OR = 2.15, P = 0.04), or dyspnea (OR = 2.29, P = 0.04). Death rates within 6 months were higher for the hospitalized patients (50.0% vs 18.7%, P < 0.01). Conclusions: Patients with cancer who visited the ED within 30-days of receiving intravenous chemotherapy often require hospitalization. We identified factors associated with higher likelihood of hospitalization, including patient characteristics, presenting symptoms, and the day of the week. Our findings should inform future efforts to enhance care delivery and outcomes for patients with cancer receiving chemotherapy.

22 Background: ED utilization among patients with cancer is often cited as a potential metric to improve the quality of oncology care. However, efforts to understand emergency department (ED) utilization among patients with cancer receiving IV chemotherapy are lacking. We sought to describe sociodemographic and clinical factors associated with ED utilization and explore predictors of ED arrival time. Methods: We conducted a quality improvement assessment of patients who visited the ED within 30-days of receiving IV chemotherapy at Massachusetts General Hospital from October 2017 to January 2018. We used descriptive statistics to describe the sociodemographic and clinical factors associated with ED visits. We used multivariable regression models to explore predictors of the following outcomes: (1) ED visit occurring during normal clinic hours; and (2) ED visit occurring during the weekend. Results: Of the approximately 2,600 patients receiving IV chemotherapy during the assessment period, we identified 500 ED visits (~19.2%). For these ED visits, median patient age was 65 years (range: 22-93), and 49.6% were female. The majority were white race (84.8%), married (63.6%), diagnosed with metastatic disease (70.4%), and 8+ days since receiving most recent chemotherapy (71.4%). The most common cancer types were gastrointestinal (24.2%), lung (13.2%), and lymphomas (11.0%). The most common reason for ED visits included pain (20.4%), fever/cold symptoms (18.0%), and fatigue (11.0%). Over half (50.4%) of ED visits occurred during normal clinic hours and over one-fourth (28.2%) occurred during the weekend. We found that ED visits were less likely to occur during normal clinic hours for patients with lymphomas (OR = 0.44, P = 0.013) compared with other cancer types. ED visits were less likely to occur during the weekend for patients of older age (OR = 0.98, P = 0.020). Conclusions: We identified a substantial number of ED visits among patients with cancer within 30-days of receiving IV chemotherapy, often occurring during normal clinic hours and most commonly for pain, fever/cold symptoms, and fatigue. These findings highlight issues to address when seeking to reduce ED utilization and enhance cancer care quality.