Visitas potencialmente evitables a servicios de emergencia en adultos con cáncer avanzado que reciben cuidados paliativos: frecuencia, características y factores asociados. Revisión sistemática
DOI:
https://doi.org/10.71112/7hq1ky67Schlagwörter:
Cuidados paliativos, Cáncer avanzado, Servicios de emergencia, Visitas evitables, Atención al final de la vida, Utilización de servicios de salud, Revisión sistemática.Abstract
Las consultas a los servicios de emergencia son frecuentes en pacientes con cáncer avanzado y pueden aumentar durante las etapas finales de la enfermedad. Aunque muchas responden a complicaciones que requieren atención urgente, otras podrían manejarse mediante control sintomático anticipado, atención ambulatoria o acceso oportuno a cuidados paliativos. El objetivo de esta revisión sistemática fue determinar la frecuencia de visitas potencialmente evitables a los servicios de emergencia en adultos con cáncer avanzado que reciben cuidados paliativos, así como describir sus características y los factores asociados. Se realizó una revisión sistemática siguiendo las recomendaciones PRISMA 2020. Se incluyeron estudios originales en adultos con cáncer avanzado, terminal o incurable bajo atención paliativa que evaluaran explícitamente la evitabilidad de las consultas a emergencia. La calidad metodológica se valoró mediante herramientas del Joanna Briggs Institute según el diseño de cada estudio y, debido a la heterogeneidad clínica y metodológica, se efectuó una síntesis narrativa. De 500 registros identificados inicialmente, cuatro estudios cumplieron los criterios de inclusión. La proporción de visitas clasificadas como potencialmente evitables osciló entre 19 % y 51,5 %. Los motivos más relacionados con estas consultas fueron dolor susceptible de manejo ambulatorio, estreñimiento, deshidratación y problemas con la disponibilidad de medicación; por el contrario, disnea, infección, fiebre, sangrado y alteraciones neurológicas fueron más frecuentes entre las consultas consideradas necesarias. La evidencia también sugiere que el acceso temprano a cuidados paliativos, el seguimiento prolongado y la disponibilidad de alternativas asistenciales fuera del hospital pueden reducir la utilización de emergencia. La ausencia de una definición uniforme de visita potencialmente evitable limita la comparación entre estudios. Se requieren criterios reproducibles y una mejor caracterización del contexto asistencial para identificar qué consultas pueden prevenirse de manera segura.
Downloads
Literaturhinweise
Alandonisi, M. M., Al-Malki, H. J., Bahaj, W., & Alghanmi, H. A. (2023). Characteristics of Emergency Visits Among Lung Cancer Patients in Comprehensive Cancer Center and Impact of Palliative Referral. Cureus, 15(4), e37903. https://doi.org/10.7759/cureus.37903
Alsirafy, S. A., Raheem, A. A., Al-Zahrani, A. S., Mohammed, A. A., Sherisher, M. A., El-Kashif, A. T., & Ghanem, H. M. (2016). Emergency Department Visits at the End of Life of Patients With Terminal Cancer: Pattern, Causes, and Avoidability. American Journal of Hospice and Palliative Medicine, 33(7), 658–662. https://doi.org/10.1177/1049909115581819
Araujo-Meléndez, M., Alcalde-Castro Mirza Jacqueline and de-la-O-Murillo, A., Hernández-Gilsoul, T., Soto-Pérez-de-Celis, E., Gonzalez-Salazar, R., & Chávarri-Guerra, Y. (2025). Potentially Avoidable Emergency Department Visits Among Patients with Advanced Cancer. Ecancermedicalscience, 19.
Barbera, L., Taylor, C., & Dudgeon, D. (2010). Why do patients with cancer visit the emergency department near the end of life? CMAJ, 182(6), 563–568. https://doi.org/10.1503/cmaj.091187
Barker, T. H., Hasanoff, S., Aromataris, E., Stone, J. C., Leonardi-Bee, J., Sears, K., Klugar, M., Tufanaru, C., Moola, S., Liu, X. L., & Munn, Z. (2026). The revised JBI critical appraisal tool for the assessment of risk of bias for analytical cross-sectional studies. JBI Evidence Synthesis, 24(3), 401–408. https://doi.org/10.11124/JBIES-24-00523
Borraccino, A., Campagna, S., Politano, G., Dalmasso, M., Dimonte, V., & Gianino, M. M. (2020). Predictors and trajectories of ED visits among patients receiving palliative home care services: findings from a time series analysis (2013-2017). BMC Palliative Care, 19(1), 126. https://doi.org/10.1186/s12904-020-00626-w
Chiaruttini, M. V., Corli, O., Pizzuto, M., Nobili, A., Fortini, G., Fortino, I., Leoni, O., & Bosetti, C. (2022). Palliative medicine favourably influences end-of-life cancer care intensity: a large retrospective database study. BMJ Supportive & Palliative Care, 14(e1), e1293–e1301. https://doi.org/10.1136/spcare-2022-004050
Connolly, C., & Connolly, E. (2026). What Makes an Emergency Visit “Avoidable”? A Qualitative Systematic Review of Multidisciplinary Clinician Perspectives on Acute Oncology Care Delivery. American Journal of Hospice and Palliative Medicine, 10499091261459768. https://doi.org/10.1177/10499091261459769
Cornillon, P., Loiseau, S., Aublet-Cuvelier, B., & Guastella, V. (2016). Reasons for transferral to emergency departments of terminally ill patients - a French descriptive and retrospective study. BMC Palliative Care, 15(1), 87. https://doi.org/10.1186/s12904-016-0155-y
Delgado-Guay, M. O., Kim, Y. J., Shin, S. H., Chisholm, G., Williams, J., Allo, J., & Bruera, E. (2015). Avoidable and unavoidable visits to the emergency department among patients with advanced cancer receiving outpatient palliative care. Journal of Pain and Symptom Management, 49(3), 497–504. https://doi.org/10.1016/j.jpainsymman.2014.07.007
Deniau, N., Shojaei, T., Georges, A., Danis, J., Czapiuk, G., Mercier, S., Maari, C., Pourchet, S., Balladur, E., & Leclaire, C. (2024). Home emergency response team for the seriously ill palliative care patient: feasibility and effectiveness. BMJ Supportive & Palliative Care, 14(2), 187–190. https://doi.org/10.1136/spcare-2023-004385
Dumnui, N., Nagaviroj, K., & Anothaisintawee, T. (2022). A study of the factors associated with emergency department visits in advanced cancer patients receiving palliative care. BMC Palliative Care, 21(1), 197. https://doi.org/10.1186/s12904-022-01098-w
Fleshner, L., Lagree, A., Shiner, A., Alera, M. A., Bielecki, M., Grant, R., Kiss, A., Krzyzanowska, M. K., Cheng, I., Tran, W. T., & Gandhi, S. (2023). Drivers of Emergency Department Use Among Oncology Patients in the Era of Novel Cancer Therapeutics: A Systematic Review. The Oncologist, 28(12), 1020–1033. https://doi.org/10.1093/oncolo/oyad161
Gajra, A., Jeune-Smith, Y., Balanean, A., Miller, K. A., Bergman, D., Showalter, J., & Page, R. (2023). Reducing Avoidable Emergency Visits and Hospitalizations With Patient Risk-Based Prescriptive Analytics: A Quality Improvement Project at an Oncology Care Model Practice. JCO Oncology Practice, 19(5), e725–e731. https://doi.org/10.1200/OP.22.00307
Green, E., Shaw, S. E., & Harris, T. (2019). “They shouldn’t be coming to the ED, should they?” A qualitative study of why patients with palliative care needs present to the emergency department. BMJ Supportive & Palliative Care, 9(4), e29. https://doi.org/10.1136/bmjspcare-2015-000999
Hirvonen, O. M., Leskelä, R.-L., Grönholm, L., Haltia, O., Voltti, S., Tyynelä-Korhonen, K., Rahko, E. K., Lehto, J. T., & Saarto, T. (2020). The impact of the duration of the palliative care period on cancer patients with regard to the use of hospital services and the place of death: a retrospective cohort study. BMC Palliative Care, 19, 37. https://doi.org/10.1186/s12904-020-00547-8
Jeung, Y. S., Bae, S. A., Lee, S. Y., Sim, J.-A., Keam, B., & Yoo, S. H. (2025). ED Visits Among Patients With Advanced Cancer Referred to Outpatient Palliative Care. JAMA Network Open, 8(7), e2521101. https://doi.org/10.1001/jamanetworkopen.2025.21101
Kaufmann, T. L., Rendle, K. A., Aakhus, E., Nimgaonkar, V., Shah, A., Bilger, A., Gabriel, P. E., Trotta, R., Braun, J., Shulman, L. N., Bekelman, J. E., & Barg, F. K. (2020). Views From Patients With Cancer in the Setting of Unplanned Acute Care: Informing Approaches to Reduce Health Care Utilization. JCO Oncology Practice, 16(11), e1291–e1303. https://doi.org/10.1200/OP.20.00013
Khalil, H., Bennett, M., Godfrey, C., McInerney, P., Munn, Z., & Peters, M. (2019). Evaluation of the JBI scoping reviews methodology by current users. International Journal of Evidence-Based Healthcare. https://doi.org/10.1097/XEB.0000000000000202
Lash, R. S., Hong, A. S., Bell, J. F., Reed, S. C., & Pettit, N. (2022). Recognizing the emergency department’s role in oncologic care: a review of the literature on unplanned acute care. Emergency Cancer Care, 1(1), 6. https://doi.org/10.1186/s44201-022-00007-4
Longhini, J., Ambrosi, E., Raber, C., Mezzalira, E., & Canzan, F. (2025). Reasons to Access the Emergency Department by Patients Who Receive Palliative Home Care: A Scoping Review. Dimensions of Critical Care Nursing, 44(4), 186–195. https://doi.org/10.1097/DCC.0000000000000702
Mosenzon, O., Blicher, T. M., Rosenlund, S., Eriksson, J. W., Heller, S., Hels, O. H., Pratley, R., Sathyapalan, T., Desouza, C., Abramof, R., Alpenidze, D., Aronoff, S., Astamirova, K., Barker, B., Bedel, G., Belousova, L., Benson, M., Beshay, I., Biggs, W., … Zhdanova, E. (2019). Efficacy and safety of oral semaglutide in patients with type 2 diabetes and moderate renal impairment (PIONEER 5): a placebo-controlled, randomised, phase 3a trial. The Lancet Diabetes and Endocrinology, 7(7), 515–527. https://doi.org/10.1016/S2213-8587(19)30192-5
Nåhls, N.-S., Anttonen, A., Löyttyniemi, E., Jekunen, A., Akrén, O., & Saarto, T. (2024). End-of-Life Care and Use of Hospital Resources in Radiotherapy-Treated Cancer Patients with Brain Metastases: A Single-Institution Retrospective Study. Palliative Medicine Reports, 5(1), 316–323. https://doi.org/10.1089/pmr.2024.0017
Oh, T. K., Jo, Y. H., & Choi, J. W. (2018). Associated factors and costs of avoidable visits to the emergency department among cancer patients: 1-year experience in a tertiary care hospital in South Korea. Supportive Care in Cancer, 26(11), 3671–3679. https://doi.org/10.1007/s00520-018-4195-0
Ouchi, K., George, N., Revette, A. C., Hasdianda, M. A., Fellion, L., Reust, A., Powell, L. H., Sudore, R., Schuur, J. D., Schonberg, M. A., Bernstein, E., Tulsky, J. A., & Block, S. D. (2019). Empower Seriously Ill Older Adults to Formulate Their Goals for Medical Care in the Emergency Department. Journal of Palliative Medicine, 22(3), 267–273. https://doi.org/10.1089/jpm.2018.0360
Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., … Moher, D. (2021). The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Systematic Reviews, 10(1). https://doi.org/10.1186/s13643-021-01626-4
Page, M. J., Moher, D., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., Mcdonald, S., … Mckenzie, J. E. (2021). PRISMA 2020 explanation and elaboration: Updated guidance and exemplars for reporting systematic reviews. In The BMJ (Vol. 372). BMJ Publishing Group. https://doi.org/10.1136/bmj.n160
Rethlefsen, M. L., Kirtley, S., Waffenschmidt, S., Ayala, A. P., Moher, D., Page, M. J., Koffel, J. B., Blunt, H., Brigham, T., Chang, S., Clark, J., Conway, A., Couban, R., de Kock, S., Farrah, K., Fehrmann, P., Foster, M., Fowler, S. A., Glanville, J., … Young, S. (2021). PRISMA-S: an extension to the PRISMA Statement for Reporting Literature Searches in Systematic Reviews. Systematic Reviews, 10(1). https://doi.org/10.1186/s13643-020-01542-z
Salama, H., Omer, M. H., Shafqat, A., Binahmed, A., Alghamdi, G. M., Saeed, M., Alfagi, M. M., Alqahtany, B. S., Alshoshan, F., Salih, D., Hashim, A., Alkaiyat, M., & Algarni, A. (2024). Avoidable emergency department visits among palliative care cancer patients: novel insights from Saudi Arabia and the Middle East. BMC Palliative Care, 23(1), 60. https://doi.org/10.1186/s12904-024-01389-4
Verhoef, M.-J., de Nijs, E. J. M., Ootjers, C. S., Fiocco, M., Fogteloo, A. J., Heringhaus, C., Marijnen, C. A. M., Horeweg, N., & van der Linden, Y. M. (2020). End-of-Life Trajectories of Patients With Hematological Malignancies and Patients With Advanced Solid Tumors Visiting the Emergency Department: The Need for a Proactive Integrated Care Approach. American Journal of Hospice and Palliative Medicine, 37(9), 692–700. https://doi.org/10.1177/1049909119896533
Wallace, E. M., Cooney, M. C., Walsh, J., Conroy, M., & Twomey, F. (2013). Why do Palliative Care Patients Present to the Emergency Department? Avoidable or Unavoidable? American Journal of Hospice and Palliative Medicine, 30(3), 253–256. https://doi.org/10.1177/1049909112447285
Downloads
Veröffentlicht
Ausgabe
Rubrik
Lizenz
Copyright (c) 2026 Fabián Patricio Paredes Velasco, Isaac Jessua Castillo Barreno, Abigail Estefanía Quishpe Briones, Byron Andres Chamba Lapo, Patricia Fernanda Galárraga Carrillo (Autor/a)
Dieses Werk steht unter der Lizenz Creative Commons Namensnennung 4.0 International.
