Cancer patients face special challenges in addition to the disease — like complications from chemotherapy and weakened immune systems.
Hospitals are recognizing that cancer patients need special emergency care, too.
Living with cancer
Richard Schwartz is 64 years old. He’s happily married. He’s vice president of an aluminum processing company in Arlington. He also has Stage 4 terminal pancreatic cancer.
He was diagnosed a year and a half ago. And while the diagnosis didn’t surprise him – since his father died of pancreatic cancer – it still shook him.
“I’ve always eaten well. I’m not overweight. I haven’t done anything bizarre – like I’m not a mountain climber,” Schwartz said. “I didn’t work in a trichloroethylene factory, where you would maybe anticipate something like that.”
Trichloroethylene is chemical compound in industrial solvents that has been linked to kidney and liver cancers. Schwartz took the news largely in stride, though. He stays busy, continues to work and tries not to think about the fact that he’s probably going to die within a year. That weight has been easier to shoulder since he stopped chemotherapy.
“I was very weak, very tired and very sick because the chemo had knocked my hemoglobin count way down,” he said.
A low hemoglobin count means fewer red blood cells and less oxygen in the body.
“I think I had 13 or 15 blood transfusions,” Schwartz said. “I ended up back in the hospital through the emergency room for 20 days,” following whipple surgery, a complex operation to remove part of the pancreas, part of the small intestine and the gallbladder.
Avoiding the emergency room
Ending up in the emergency room is exactly what the oncologists at UT Southwestern don’t want.
At the urgent cancer care clinic at UT Southwestern’s Simmons Comprehensive Cancer Center, the goal is to treat cancer-specific emergencies without having to admit patients to the hospital – emergencies like nausea, vomiting, pain, skin rash, fever, chills and fatigue.
Sheeba Cantanelli is a physician assistant at the urgent care clinic, which opened about four years ago. She said these aren’t necessarily life threatening problems, but they do need to be taken care of quickly – and that’s best done outside of the ER.
Say, someone has nausea:
“[The ER] might treat the symptom and look for the most typical reasons why they’re nauseated – such as a virus – but we’ve got to look at if it’s because they have some new brain metastases or if it’s the result of some oral chemotherapy that we have to stop,” Cantanelli said. “So there are some disease and treatment-specific interventions that we can do here that [the ER], because they treat the general population, would approach differently.”
And because cancer patients tend to have compromised immune systems from chemotherapy, sending them to an emergency room full of other sick patients could put them at risk. ER doctors aren't always trained to deal with cancer either, which can lead to unnecessary and costly hospital stays.
Saving time and money
In 2013, a health care research firm called Advisory Board found that only a fifth of cancer programs in the country offered urgent care – with 30 percent saying they routinely send all patients with urgent symptoms straight to the emergency department.
At UT Southwestern, triage nurses offer a first line of support. They try to answer questions and handle less serious concerns over the phone. That way, those who end up having to visit the clinic in person get the most efficient care.
“I don’t think I ever waited more than 8-10 minutes,” said Richard Schwartz. “Within another five or 10 minutes, you’re having blood drawn, and within an hour, I knew what was wrong with me – and in a lot of instances, then being treated for it, too.”
“Our patients spend so much time getting health care, they don’t want to spend any added time in the hospital,” said Dr. Tom Froehlich, who is the medical director of the Simmons Cancer Center. He said when the clinic first opened and resources were still limited, they did have to send a lot of patients to the ER.
“Now, we’re down to where probably 65-70 percent of the patients are actually sent home after treatment here – and only about 30-35 percent end up getting admitted to the hospital,” Froehlich said.
He also pointed out the sizable cost difference: “If you go to the emergency room, you’re going to get scans and all kinds of things. It’s not at all hard to leave the emergency room with a bill of $5,000-$10,000.”
In contrast, Froehlich said in urgent care, a standard visit could cost patients a few hundred dollars – about a tenth of the bill from the emergency room.
Those are promising numbers, and more hospitals are starting to meet this specialized need. Johns Hopkins in Baltimore has also opened up an urgent cancer care clinic in the past few years, and MD Anderson in Houston operates an emergency center dedicated to cancer patients.
Still, Dr. Froehlich at UT Southwestern says that can be a challenge for many hospitals.
“Where would you hold it? Who would staff it? Who would be responsible for it? How would you have enough specialized care?” he asked.
Still, for Richard Schwartz, the clinic has done wonders. He said urgent care is a worthwhile investment for cancer patients.
“They need to be treated differently. Because a lot of the people who go to those cancer treatment facilities are in the process of dying, so it really requires, I feel, a different caliber of personnel who can handle those kind of people.”
Schwartz said his prognosis isn’t certain – but he’s prepared for what could be his last year. Keeping a good attitude has been easy for him though – with a family that supports him and a cancer team that does, too.