414 Background: Unplanned emergency department visits and hospitalizations, collectively referred to as Acute Care Events (ACEs), cost up to 60 billion annually in the US and impose a heavy burden on patients and health systems, while up to 40% are thought to be preventable. Some studies have shown that YAs (Young Adults, aged 18-39 years) face more ACEs than other age groups and for different reasons, but this has not been well studied to date. We sought to quantify the proportion of ACEs experienced by AYAs initiating cancer treatment that are potentially preventable along with the reasons for those ACEs to facilitate efforts at reduction. Methods: We conducted a retrospective cohort analysis of adults with cancer initiating systemic anti-cancer therapy within a single academic medical center or one of its six community affiliates using electronic health record (EHR) data. We included all patients with any type of cancer initiating a new episode of therapy in 2022 (as evidenced by no therapy administration in the prior 6 months), compiling EHR data for one-year pre/post therapy initiation excluding patients aged 21 years or less. The primary outcome of this analysis was the occurrence of an ACE (ED visit or unplanned hospitalization) within 30 days of cancer treatment plan initiation. We used the primary diagnosis associated with the ACE to assign ACE indication and to categorize each ACE as potentially preventable or not, based on the diagnoses from the CMS OP-35. We report the rate of ACE for YAs (those aged 21-40 years) and compare the primary diagnoses associated with ACEs for YAs and older adults (aged 40+ years). Results: Our cohort included 4, 697 patients, 292 were YAs (6. 2%). Of these, non-YAs experienced an ACE (15. 8% of YAs, 16. 7% of non-YAs) within 30 days of treatment plan initiation. On average, YAs experienced an average of 0. 19 per patient, compared with an average of 0. 21 for non-YAs. The total proportion of potentially preventable visits was 34. 5% among YAs compared with 25. 0% of non-YAs (p = 0. 115). Notably, the reasons for admission differed (Table), with YAs more likely to present with pain (16. 4% vs 7. 3%, p = 0. 03) and emesis (3. 6% vs 0. 2%, p = 0. 017). Sepsis was less common among YAs (3. 6% vs 6. 6%, p = 0. 57) but this did not reach statistical significance. Conclusions: In a single center analysis, YAs faced a higher burden of potentially preventable ACE compared with non-YAs, although this did not meet statistical significance. The reasons for admission differed, with pain and vomiting more common for younger patients. Future studies should investigate this in a larger cohort. The insight into differing reasons for admission by age group may help target symptom improvements efforts to prevent ACE for YAs. Proportion of potentially preventable diagnoses among all ACE by age group. Diagnosis Non-AYA AYA p value Emesis 0. 2% 3. 6% 0. 017 Nausea 1. 5% 3. 6% 0. 22 Neutropenia 1. 3% 3. 6% 0. 18 Pain 7. 3% 16. 4% 0. 033 Sepsis 6. 6% 3. 6% 0. 57
Stein et al. (Wed,) studied this question.