Improving Cancer Survival and Reducing Treatment Variations With Protocols for Emergency Care

Study Overview
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Brief Summary
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Significant challenges and gaps remain in navigating transitions between acute care and outpatient care for many cancer survivors. This study underscores 1) implementation of Emergency Department (ED) risk-stratified treatments protocols that standardize patient care and would allow for rapid re-assessment and access to specialist care with well-coordinated cancer care plans, and 2) the significant numbers of minority cancer survivors seeking episodic care in the ED that are at increased risk of not receiving recommended post cancer treatment surveillance.

Detailed Description
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The over-arching goal of this study is to develop a portable model for ED cancer treatment guidelines and management using evidence based protocols in a population at high risk for poor cancer -related outcomes by identifying & overcoming specific barriers to enhanced survivorship. Based on the demographics of ED population (currently, 70% racial/ethnic minorities), the majority of participants will be underrepresented (African-American and Hispanic) and low-income individuals. The investigators propose a feasibility study of 150 patients in the ED over a 1 year period. The specific aims are: Aim 1: Evaluate the effectiveness of ED Risk-Stratified, Evidence-Based Treatment protocols on the primary outcome of ED utilization rates and subsequent acute inpatient admissions at 6 -months post-intervention. Aim 2: Evaluate the effectiveness of an ED-based Cancer Patient Navigator on the secondary outcomes of patient engagement and primary care engagement at 6 -months post-intervention. Aim 3: Examine barriers and facilitators to compliance for cancer survivorship recommendations that occur in an ED setting at 6-months post intervention.

Official Title
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Improving Cancer Survival and Reducing Treatment Variations With Protocols for Emergency Care (ICARE)

Conditions
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Cancer

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Cancer survivor (has had cancer in their lifetime, and is currently disease-free) Verbal fluency in English or Spanish Age 18-75 years Exclusion Criteria: Unable to verbalize comprehension of study or impaired decision making (e.g., dementia) Plans to move from Chicago area within the next year

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 75 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| ED utilization rate | Emergency department utilization over 6 month period | 6 months from study entry | 
| Mortality | Mortality due to deep vein thrombosis/pulmonary embolism, due to sepsis, and overall mortality | 30 days from study entry | 
| Mortality | Mortality due to deep vein thrombosis/pulmonary embolism, due to sepsis, and overall mortality | 90 days from study entry | 
| Mortality | Mortality due to deep vein thrombosis/pulmonary embolism, due to sepsis, and overall mortality | 1 year from study entry | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Admission and Readmission rate | all cause, and related to sepsis | 6 months from study entry |