{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,2]],"date-time":"2026-03-02T14:24:22Z","timestamp":1772461462469,"version":"3.50.1"},"reference-count":31,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2018,8,17]],"date-time":"2018-08-17T00:00:00Z","timestamp":1534464000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer Medicine"],"published-print":{"date-parts":[[2018,9]]},"abstract":"Abstract<\/jats:title>Background<\/jats:title>Cancer patients contribute significantly to emergency department (ED<\/jats:styled-content>) utilization. The objective of this study was to identify factors associated with patients becoming ED<\/jats:styled-content> frequent attenders (FA<\/jats:styled-content>) after a cancer\u2010related hospitalization.<\/jats:p><\/jats:sec>Methods<\/jats:title>A retrospective cohort study was conducted using national administrative, billing, and death records of Singapore residents discharged alive from Singapore public hospitals from January 2012 to December 2015, with a primary discharge diagnosis of cancer. Patients with four or more ED<\/jats:styled-content> visits within any 12\u2010month period after discharge from their index hospitalization were classified as FA<\/jats:styled-content>. Time to FA<\/jats:styled-content> distribution was estimated using the Kaplan\u2010Meier method, and factors associated with risk of FA<\/jats:styled-content> were identified using multivariate Cox regression analyses.<\/jats:p><\/jats:sec>Results<\/jats:title>Records for 47\u00a0235 patients were analyzed, of whom 2980 patients were FA<\/jats:styled-content> within the study period. Age (<17\u00a0years, hazard ratio [HR<\/jats:styled-content>] 2.92, 95% CI<\/jats:styled-content> 2.28\u20103.74; 75\u201084\u00a0years, HR<\/jats:styled-content> 1.29, 95% CI<\/jats:styled-content> 1.16\u20101.45; and \u226585\u00a0years, HR<\/jats:styled-content> 1.71, 95% CI<\/jats:styled-content> 1.45\u20102.02, relative to age 55\u201064), male gender (HR<\/jats:styled-content> 1.26, 95% CI<\/jats:styled-content> 1.16\u20101.37), Charlson comorbidity index (HR<\/jats:styled-content> 1.21, 95% CI<\/jats:styled-content> 1.19\u20101.23), and socioeconomic factors (Medifund use, HR<\/jats:styled-content> 1.40, 95% CI<\/jats:styled-content> 1.23\u20101.59; housing subsidy type, HR<\/jats:styled-content> 2.12, 95% CI<\/jats:styled-content> 1.77\u20102.54) were associated with increased risk of FA<\/jats:styled-content>. Primary malignancies associated with FA<\/jats:styled-content> included brain and spine (HR<\/jats:styled-content> 2.51, 95% CI<\/jats:styled-content> 1.67\u20103.75), head and neck cancers (tongue, HR<\/jats:styled-content> 2.05, 95% CI<\/jats:styled-content> 1.27\u20103.31; hypopharynx, HR<\/jats:styled-content> 2.72, 95% CI<\/jats:styled-content> 1.56\u20104.74), lung (trachea and lung, HR<\/jats:styled-content> 1.57, 95% CI<\/jats:styled-content> 1.13\u20102.18; pleural, HR<\/jats:styled-content> 3.69, 95% CI<\/jats:styled-content> 2.12\u20106.34), upper gastrointestinal (stomach, HR<\/jats:styled-content> 1.93, 95% CI<\/jats:styled-content> 1.26\u20102.74; esophagus, HR<\/jats:styled-content> 4.13, 95% CI<\/jats:styled-content> 2.78\u20106.13), hepato\u2010pancreato\u2010biliary (liver, HR<\/jats:styled-content> 1.42, 95% CI<\/jats:styled-content> 1.01\u20102.00, pancreas, HR<\/jats:styled-content> 2.48, 95% CI<\/jats:styled-content> 1.72\u20103.59), and certain hematological malignancies (diffuse non\u2010Hodgkin's lymphoma, HR<\/jats:styled-content>1.59, 95% CI<\/jats:styled-content> 1.08\u20102.33, lymphoid leukemia, HR<\/jats:styled-content> 1.86, 95% CI<\/jats:styled-content> 1.21\u20102.86). Brain (HR<\/jats:styled-content> 1.69, 95% CI<\/jats:styled-content> 1.27\u20102.26), lung (HR<\/jats:styled-content> 1.31, 95% CI<\/jats:styled-content> 1.01\u20101.71), liver (HR<\/jats:styled-content> 1.46, 95% CI<\/jats:styled-content> 1.14\u20101.89), and bone (HR<\/jats:styled-content> 1.35, 95% CI<\/jats:styled-content> 1.04\u20101.76) metastases were also associated with FA<\/jats:styled-content>.<\/jats:p><\/jats:sec>Conclusion<\/jats:title>There are cancer\u2010specific factors contributing to ED<\/jats:styled-content> frequent attendance. Additional resources should be allocated to support high\u2010risk groups and prevent unnecessary ED<\/jats:styled-content> use.<\/jats:p><\/jats:sec>","DOI":"10.1002\/cam4.1728","type":"journal-article","created":{"date-parts":[[2018,8,17]],"date-time":"2018-08-17T09:49:32Z","timestamp":1534499372000},"page":"4434-4446","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":23,"title":["Cancer patients as frequent attenders in emergency departments: A national cohort study"],"prefix":"10.1002","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9234-4529","authenticated-orcid":false,"given":"Ting Hway","family":"Wong","sequence":"first","affiliation":[{"name":"Singapore General Hospital Singapore Singapore"},{"name":"Duke\u2010National University of Singapore Medical School Singapore Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zheng Yi","family":"Lau","sequence":"additional","affiliation":[{"name":"Policy Research and Evaluation Division Ministry of Health Singapore Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Whee Sze","family":"Ong","sequence":"additional","affiliation":[{"name":"National Cancer Centre Singapore Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kelvin Bryan","family":"Tan","sequence":"additional","affiliation":[{"name":"Policy Research and Evaluation Division Ministry of Health Singapore Singapore"},{"name":"Saw Swee Hock School of Public Health Singapore Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yu Jie","family":"Wong","sequence":"additional","affiliation":[{"name":"Policy Research and Evaluation Division Ministry of Health Singapore Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohamad","family":"Farid","sequence":"additional","affiliation":[{"name":"Duke\u2010National University of Singapore Medical School Singapore Singapore"},{"name":"National Cancer Centre Singapore Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Melissa Ching Ching","family":"Teo","sequence":"additional","affiliation":[{"name":"Duke\u2010National University of Singapore Medical School Singapore Singapore"},{"name":"National Cancer Centre Singapore Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alethea Chung Pheng","family":"Yee","sequence":"additional","affiliation":[{"name":"Duke\u2010National University of Singapore Medical School Singapore Singapore"},{"name":"National Cancer Centre Singapore Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hai V.","family":"Nguyen","sequence":"additional","affiliation":[{"name":"School of Pharmacy Memorial University of Newfoundland St John's Newfoundland Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marcus Eng Hock","family":"Ong","sequence":"additional","affiliation":[{"name":"Singapore General Hospital Singapore Singapore"},{"name":"Duke\u2010National University of Singapore Medical School Singapore Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"N. 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