Cancer Pain Most Common Symptom Before Acute Care Visits

Medscape

09-05-2025

Pain, nausea, and vomiting were the most frequently documented symptoms preceding unplanned acute care visits in patients with cancer, new research showed. Women, individuals from racial minority groups, and those with Medicaid insurance were more likely to have a high symptom burden, although men and White patients accounted for most of the visits.
METHODOLOGY:
Many patients with cancer require unplanned acute care, including emergency department (ED) visits and hospitalizations, due to complications from their disease or treatment. These encounters affect outcomes, quality of life, and healthcare costs. However, little is known about symptom patterns preceding such visits.
A cohort study conducted at a single tertiary-care institution analyzed outcomes from 28,708 adult patients with cancer who had symptoms documented in the 30 days before an acute care visit.
Researchers used natural language processing to scan clinical notes for symptoms recorded in the 30 days before an ED visit or hospital stay. High symptom burden was defined as more than 10 different symptoms noted during that time.
The primary outcomes were symptom burden and characterization of symptoms preceding acute care visits. Secondary outcomes included associations between symptom burden and sociodemographic characteristics (sex, race and ethnicity, age, and insurance type).
TAKEAWAY:
Overall, 70,606 acute care encounters were observed, and 854,830 symptoms were documented before an acute care visit. Men had 53.6% of the acute care encounters, and White patients had about 56.6%.
The top 10 most common documented symptoms were pain (7.54%), nausea (6.74%), vomiting (5.79%), fatigue (5.26%), constipation (3.93%), fever (3.39%), generalized muscle weakness (3.32%), extremity edema (3.28%), dyspnea (3.12%), and headache (2.92%).
Women (adjusted odds ratio [aOR], 1.14); patients of Asian (aOR, 1.22), Black (aOR, 1.17), and American Indian or Alaska Native (aOR, 1.21) races; and Medicaid-insured patients (aOR, 1.10) were significantly more likely to have a documented high symptom burden.
Patients aged 65 years or older (aOR, 0.96) and those without insurance (aOR, 0.58) were significantly less likely to have a documented high symptom burden preceding an acute care visit.
IN PRACTICE:
'This analysis highlights differences in cancer symptom documentation across racial, sex, and socioeconomic subgroups, suggesting potential areas of disparities. This raises attention to the potential need to develop targeted interventions to ensure equitable access to health care for improved symptom management,' the authors wrote.
SOURCE:
This study, led by Chichi Chang, MEng, Bakar Computational Health Sciences Institute, University of California San Francisco, was published online in JAMA Network Open .
LIMITATIONS:
The limitations included retrospective design, single-center study, potentially incomplete data, and a predominantly White and insured population. Natural language processing methods could have limitations in accurately capturing complex clinical documentation. Repeated visits by the same patients might have biased symptom data.
DISCLOSURES:
This study received support from a National Cancer Institute of the National Institutes of Health grant, a Conquer Cancer Career Development Award, and a University of California San Francisco Computational Cancer Award. One author reported providing paid services to Epi-Vant Consulting, outside the submitted work. Another author reported receiving grants from Roche, outside the submitted work.