An Inflection Point in the Evolution of Oncologic Emergency Medicine.

INTRODUCTION In what has become a near-weekly ritual, one of us (K.H.T.) receives an emotionally laden call about the plight of a loved one, colleague, or acquaintance with cancer who needs our help to navigate the labyrinth of emergency care. The patient may receive care at our comprehensive cancer center but become “stranded” in an emergency department (ED) outside the often rigid borders between our center and other health care systems. They may be only a few blocks away, or in another town, state, or country. Usually, after a flurry of calls or e-mails, the patient is accepted into one of our clinics. At times, the patient must sign out against medical advice to come directly to our ED. These exercises often end with the caller’s tremendous expressions of gratitude, thanking us for being “miracle workers.” However, it shouldn’t take a miracle to communicate and deliver high-quality patient-centered care in the ED. Every year, between 1 and 3 million US ED visits are related to cancer. The visits may be the index presentation leading to an eventual cancer diagnosis. More commonly, such visits are prompted by symptoms resulting from cancer progression, treatment toxicities, or complications of surgery. These visits weigh heavy on our patients and often portend a worsening prognosis. Because cancer is commonly a disease of aging, US EDs should expect to see increasing numbers of cancer patients and survivors as the population ages. Given projected shortages of cancer care providers, it is increasingly important for the emergency care community to better understand and expertly manage cancer emergencies. To fulfill the Triple Aim (improved patient experience, improved population health, and reduced health care costs) and effectively manage limited resources, we must foster transparent communication and collaboration between emergency physicians and the multiple professionals who participate in cancer care and research. It is vital that