Hypertension and Emergency Department Visits by Patients with Head and Neck Cancer

Background: The Emergency Department (ED) is the safety net for unanticipated or undertreated health needs. Patients with cancer have been reported to be substantial users of ED resources, to be of higher acuity than others, and to have a longer length of stay. Patients with head and neck cancer live longer than patients with other types of cancer. Therefore, we assessed the extent to which epidemiological, behavioral, and clinical factors collected prior to treatment were associated with eventual ED visits in patients with head and neck cancer. Methods: Questionnaires were administered at baseline, prior to cancer treatment. ED data were abstracted for up to 5 years follow up period from initial diagnosis and treatment of patients newly diagnosed with squamous cell carcinoma of the head and neck (HNSCC). Results: Our sample comprised 969 patients. The earliest ED visit occurred within 1 week of diagnosis. As many as 513 patients had ≥1 ED visit and the mean time to first ED visit was 27 weeks (SD=2.3 weeks). The most frequent chief complaints were: pain (n=181; 35.3% [abdominal pain=16.3%, chest pain=7.5%]); fever (n=107; 20.9%); nausea/vomiting (n=64; 12.5%); weakness/fatigue (n=45; 8.8%). Multivariate logistic regression indicated that hypertension (OR=1.43, 95% CI=1.02–2.03; P=0.039), T-stage (OR=2.05, 95% CI=1.45–2.92; P<0.0001), and N-stage (OR=1.47, 95% CI=1.17–1.86; P<0.001) were significantly associated with ED visits. Conclusion: To our knowledge, our study is the first to find a specific association between hypertension and ED visits in patients with HNSCC. Further research is needed to investigate possible reasons for the association between comorbidities such as hypertension and the need for emergent care, as well as to determine whether aggressive management of comborbid conditions during and after cancer therapy might reduce the likelihood of ED visits.