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IO Patients in the Emergency Department

By Junaid Razzak, MBBS, MD, PhD

Junaid Razzak
Junaid Razzak, MBBS, MD, PhD
Professor, Director of Telemedicine
Department of Emergency Medicine
Johns Hopkins University
Baltimore, MD

Junaid Razzak, MBBS, MD, PhD, is a professor in the Department of Emergency Medicine at Johns Hopkins University. He recently served as the founding chair of the Department of Emergency Medicine and founding director of the World Health Organization Collaborating Center at Aga Khan University in Karachi, Pakistan. Dr. Razzak is also the founding member and CEO of Aman Healthcare Services—a nonprofit organization in Karachi. Dr. Razzak played a pivotal role in the establishment of emergency medicine as a specialty in Pakistan, starting the first advanced life support service in Karachi and helping launch the largest health call center in Pakistan.

Dr. Razzak’s current research focuses on implementing and measuring health system innovations for enhancing access to emergency healthcare for vulnerable populations, especially in low- and middle-income countries. As director of telemedicine in the Emergency Medicine Department at Hopkins, Dr. Razzak is leading an innovative clinical and research program on the use of technology in improving access to emergency care.

September 13, 2018

The emergency care system serves as front-line care for all patients but especially for those who are critically ill or high risk such as individuals with cancer. Of 140 million Emergency Department (ED) visits every year in the United States, about 4 percent are made by patients with a diagnosis of cancer. While many present due to an emergency caused by the primary disease, a significant number arrive in the ED due to complications from anticancer treatment. In “A Systematic Review of Emergency Department Use Among Cancer Patients,” Lash and colleagues found that 10-12 percent of patients with cancer had at least one visit to the ED during their treatment. Of those receiving chemotherapy, about 5 percent required a visit to an emergency department within the first 30 days of the treatment.1 In fact, many patients are most vulnerable to an emergency department visit during the first few days of initiating cancer treatment. In most hospitals, when these patients come to the ED, they are cared for by residency-trained emergency physicians. Emergency physicians are partners in providing care to your acutely ill patients. Since emergency physicians’ experience with and exposure to the novel immunotherapies is relatively limited, it is important that ED and nurses are aware of the indications for these agents and informed on potential acute and chronic complications of immunotherapy for cancer. ED care of cancer patients being treated with immunotherapies can be considerably improved if there is: 

  • Clear communication between patients’ treating oncologists and emergency physicians during the patient’s treatment in the ED;
  • Critical information regarding complications and potential emergency presentations in patients being treated with immunotherapy is available at point of care and accessible 24/7 through a reliable system; and
  • Targeted online CMEs and other teaching/learning materials designed specifically for emergency physicians are available.

These could be offered through partnership with specialty societies or larger teaching hospitals/medical schools. As partners in the patient’s care both the treating oncologists and the ED physicians have perspective on what information on immunotherapies for cancer and immune-related adverse events should be available to emergency physicians. We invite you to weigh in: What information/resources are needed? What would be the best ways to communicate this information? Could resources be available both offline (through specialty societies such as ACEP) and online (live through a 24/7 dedicated national phone line) to discuss the patient’s presentation and the potential contribution of IO to the patient’s presentation? 

1. Lash RS, Bell JF, Reed SC, et al. A Systematic Review of Emergency Department Use Among Cancer Patients. Cancer Nurs. 2017;Mar-Apr;40(2):135–144. 

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