Should I Go To The ER Or To Urgent Care?

by Jane Ashley

We, as cancer patients, face difficult decisions all of the time.

Fever Over 1005 (1)

• Treatment decisions
• Getting a second opinion
• Taking a chemo break
• Type of surgery

There’s yet another decision that we may have to make. A medical “situation” occurs, and we have to decide if it’s cancer-related, treatment-related, or not related to our cancer situation at all. Where do we go? What do we do? Decisions, decisions.

What to do first?

Call your oncologist. Virtually every cancer center has a triage nurse on duty, 24 hrs./day, 7 days/week, even on holidays. These nurses are there to help us decide what to do if we develop a new symptom.

Don’t worry about calling — we are not bothering them — the triage nurse has access to our medical records and is trained to help patients distinguish between what is a medical emergency and what is a non-emergency where a patient can call their primary care physician or go to urgent care.

And now, with the COVID-19 pandemic, cancer patients especially need to seek the advice of their oncologist and their triage nurse, nurse practitioner, or on-call oncologist.

What are some medical emergencies that cancer patients face?

These are some of the more commonly-experienced medical emergencies that we might face related to our cancer and its treatment. The triage nurse will advise you whether to come into their facility or go to the emergency room. 

Infection. Both chemotherapy and radiation may compromise our bone marrow, causing us to experience low white cell counts. We might experience neutropenia, a dangerously low level of neutrophils, the white cells that fight infection. Symptoms of infection that need immediate attention include:

Fever over 100.5 degrees
• Bloody or cloudy urine
• Chest pain
• Confusion
• Severe headache with a stiff neck
• Shaking chills
• Shortness of breath

Pain

Less serious signs of an infection are cough, earache, sore throat, rash, or diarrhea. If these symptoms are persistent, it’s best to call rather than risk a mild infection developing into pneumonia or serious blood infection.

Deep vein thrombosis and pulmonary embolism. A thrombosis is a blood clot within a blood vessel, usually deep within our body, most often in one of our legs. If the blood clot moves, it could travel into our lungs, causing a pulmonary embolism. These are life-threatening medical emergencies. The symptoms include:

• Swelling in the leg or along a vein in the arm or leg
• Pain or tenderness in the leg, especially if standing or walking
• Pain or tenderness in the arm, which limits motion
• Warmth in the arm or leg that is either swollen or tender
• Redness or other discoloration in the arms or legs

If you have some of the above symptoms, the symptoms that a blood clot might have moved to our lungs include:

• Chest pain, especially when deep breathing
• Shortness of breath, breathlessness
• Coughing up blood
• Rapid breathing and/or fast heart rate

Pulmonary Embolism

Tumor lysis syndrome is an uncommon event that may occur in patients with aggressive forms of lymphoma or leukemia. TLS may occur shortly after treatment begins when a large number of cancer cells die, releasing large amounts of potassium, phosphate, and nucleic acids into the bloodstream. This event creates a metabolic imbalance that can be fatal if not recognized and promptly treated. Symptoms include:

• Nausea and vomiting
• Diarrhea
• Trouble breathing/shortness of breath
• Weakness
• Low blood pressure/irregular heartbeat
• Muscle cramping

If you are a patient at risk for TLS, your oncologist has already talked to you about TLS.

What about pain or nausea?

A recent study published in the Journal of the American Medical Association showed that 62% of ER visits by cancer patients were for pain. 31% of cancer patient ER visits were for nausea.

Pain and nausea management can’t be solved in the emergency room. We, as patients, must be proactive with our oncologist, radiologist, or surgeon if our pain or nausea is not under control. With pain medication under such strict control now, cancer patients aren’t likely to get much in the way of long term pain relief from an ER doctor. Nausea management is not an appropriate ER problem either.

Our oncologist or other cancer treatment specialist is the one that we, or our caregiver, need to talk to about pain and nausea relief.

Acute-onset pain or prolonged vomiting, which could lead to dangerous dehydration, may be a viable cause for an ER visit in the middle of the night. However, it’s best to be proactive with our healthcare team to address our pain and nausea problems before they escalate out of control.

When should we go to urgent care?

There are times when going to an urgent care cancer is the perfect solution for a “minor” medical issue. Situations where urgent care is appropriate include:

• Strains, sprains, fractures, or falls
• An insect bite
• A minor cut
• Pink eye
• Poison ivy
• Minor burns

A call to our oncologist best handles some seemingly minor symptoms like a skin rash, urinary tract infection, or sinus infection. Chemotherapy and immunotherapy may cause a bucket full of adverse reactions that don’t appear to be treatment-related. Our treatment center is almost always the best place to start — call and leave a message for the nurse-on-call. They usually get back to us quite quickly.

The Bottom Line

Always carry the number of your oncologist in your wallet along with a list of your medications. If something happens and you have to go to the emergency room, the ER staff can get in touch with someone on your cancer team to ensure that all bases are covered. You might avoid being admitted to the hospital for observation or avoid costly imaging tests that aren’t necessary.

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