From KERA:
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 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.
