Making the Emergency Room Safe for Cancer Patients

How Cancer Patients Can Protect Themselves when Visiting the ER


No one enjoys a visit to the emergency room.  For the vast majority of us, a trip to the ER means that something frightening and serious (or potentially serious) has suddenly and unexpectedly happened to us or to a loved one.  Sudden chest pain.  A deep cut.  Blacking out.  And while the symptoms and injuries that lead us to the ER vary widely, our expectations are the same:  that the emergency room is the safest place for us.

  That the ER physicians, nurses, and staff will know exactly what to do.  That they’ll rapidly figure out what’s wrong and then either provide immediate treatment or immediate next steps to find the answer.  That whether in the end all we need are a few stitches or an emergency cardiac catheterization, the ER protects our health and our lives.

But for cancer patients, the ER is not always so safe.  Because cancer patients are very different from patients without malignancies, and both the emergency room’s patients and staff may place the cancer patient at increased risk.

Emergency rooms are filled with infected patients, people who can infect those around them.  On any given Friday night, the average ER waiting room is crowded, and at least one person (often more than one) is coughing or sneezing uncontrollably.  Wiping their very runny nose every thirty seconds.  Touching their chair, the magazines, the rest room door handle.

  For cancer patients, these infected ER waiting room compatriots are a particular threat, as cancer patients are immunocompromised, making them both more vulnerable to becoming infected and at greater risk of suffering serious complications should they become infected.  And infections don’t just come from other ER patients, because these infected patients are cared for by the same doctors, nurses, and technicians who care for the ER cancer patient.

  While we certainly expect all ER workers to wash their hands between each and every patient, studies show otherwise (less than half of emergency caregivers do so).

But if you are a cancer patient, you can take some simple precautions to reduce the risk of becoming infected during your ER visit.  First, stay far, far away from anyone in the ER from who appears to have the cold, flu, or other infection (coughing, sneezing, runny nose, watery eyes).  Next, wash your hands frequently while in the waiting room and exam room (bring hand sanitizer, if you can remember), especially after touching common area items (chairs, tables, door handles).  And try to avoid touching your mouth, nose, or eyes with your hands, as this is a common route of infection.  Finally, while challenging, you must ask each ER provider on each visit if they have washed their hands.

Another danger for the ER cancer patient is more subtle: a lack of knowledge.  ER doctors, nurses, and other staff are specifically trained in emergency medicine, not in oncology.

  Thus, many ER care providers may not realize that symptoms which are minor (non-emergent) in most patients may represent a very serious, even life-threatening emergency in a cancer patient.  Low-grade fever, for example, may be of little concern in virtually everyone else, but in the cancer patient, such a finding may be the prelude to a rapidly evolving, serious infection; that is, a true emergency.  And mild vomiting may be of little real concern for most, but in patients receiving certain chemotherapy drugs, the resulting mild dehydration may truly threaten the cancer patient’s kidneys.

Most ER physicians, nurses, and other staff are also unfamiliar with the wide variety of potentially dangerous complications and side-effects of the numerous chemotherapy agents.  For example, chalking up mild arm or hand pain to poor circulation, shingles, or something else rather than recognizing chemo-induced peripheral neuropathy (a chemo side effect) may delay appropriate treatment and chemo dose modification, potentially leading to long-term neurological damage.

But here again, if you have cancer, you can actively protect yourself by providing information.  Every time you interact with an ER staff member (from the first introduction to the registration worker on), tell them that you are a cancer patient (and be specific as to the type of cancer).  Then remind the doctors and nurses caring for you, because during their twenty minute absence, they’ve seen a dozen other patients.  Be respectful, but remind the doctor on the second visit (and the third) that you have lung cancer, pancreatic cancer, whatever.  And tell them what specific chemotherapy you have recently received (carry a list).  Clearly ask if any or all of your complaints might be a side effect of your chemo.  Your asking will trigger the ER doctor to search for the answer (by quickly reading up on-line).  Be respectful but forceful until you hear (and believe) that the ER physician is certain that your chemo is not the cause of your symptoms.

So the onus falls on you, the ER cancer patient, to protect yourself from the ER.  But hopefully not for much longer.  The Ohio State University Medical Center has recently opened a new emergency department facility which includes an ER aimed specifically at caring for cancer patients.  In this pioneering model, the cancer patient ER is staffed by ER physicians and nurses who have received additional training in the evaluation and care of patients with malignancies.  We look forward to others following in this new and necessary ER model.  Because whether or not you have cancer, when you need emergency care, the ER should be the safest place to go.

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