When cancer care meets urgent care

“Oh my gosh … it was always on a Friday.”

Sitting in a chair with an IV drip attached to her arm, Amy Darragh was at the end of her first chemotherapy treatment for a rare form of bladder cancer that also affected one of her kidneys. Her diagnosis had come after recurring urinary tract infections that always seemed to crop up with the same unfortunate timing.

“I don’t know what the rhythm in my body was; it always fell on a Friday,” Darragh said. Sometimes that meant toughing it out and waiting over the weekend until she could get into her doctor’s office. Other times it meant late night trips to urgent care. Those trips eventually led to her diagnosis, “but there were moments that it would have been really nice not to wait … because it eases the anxiety.”

Darragh had surgery to remove the tumor and a kidney, and her doctor expects chemotherapy to be curative. Now, as she moves forward with this treatment, she’ll have less reason to worry about managing side effects and symptom flare-ups if they happen on a Friday, thanks to the Oncology Evaluation Center (OEC) at the Hospital of the University of Pennsylvania (HUP). It’s a bit like an urgent care specifically tailored to cancer patients, providing evaluation and symptom management for situations including dehydration, nausea, vomiting, diarrhea, and pain flares. The center is now open 24 hours per day, 7 days per week, after running for almost a decade at a smaller scale alongside regular cancer infusions at HUP. It is designed to give patients more tools in their fight against cancer and more control over their time.

“It’s so nice to tell the patients that they have a place to go on the weekends and they have that sense of relief that there’s support,” said Marie I. Carrera, CRNP, the center’s clinical coordinator.

The Oncology Evaluation Center started as a means to offer cancer patients more flexibility in their care when something came up. The idea is based on an evaluation of the reasons why many cancer patients were coming to emergency departments (EDs)—and in some cases were readmitted to the hospital.

Clinical Effectiveness and Quality Improvement Manager Erin Lightheart, MBA, pointed out that ED teams do an “amazing” job handling urgent and emergency situations. But many patients need specialized cancer care that only oncology teams are equipped to provide—which meant another hospital admission was sometimes the best available option.

The ED visit itself is something many cancer patients approach with understandable anxiety: It is not an ideal place for an immunocompromised patient to spend a lot of time. As a result, patients with cancer may wait in the ED with growing dread—or in some cases avoid seeking care quickly when symptoms come up.

For years, the center offered its services Monday through Friday for eight hours a day. But overnight and on the weekend, patients didn’t have any recourse for their needs other than a visit to the ED, noted Lightheart.

Recognizing the opportunity to offer patients more convenient care, the Oncology Evaluation Center began a trial of expanded 12-hour days and added weekend service in March 2024. Through January 2025, they found that the expanded hours saved 679 inpatient bed days and 404 ED visits. Of the patients who used the center, 91 percent were able to head home without additional ED or inpatient care.

Based on these results, the Oncology Evaluation Center expanded to 24/7 operations starting in June 2025, along with a move to a new space in the hospital with more room to treat patients.

“We’re seeing patients return to the Oncology Evaluation Center for weekend support again and again—the very patients who, without this option, might otherwise spend months in the hospital,” said Colleen Kucharczuk, DNP, CRNP, the manager of advanced practice providers for inpatient oncology services at HUP.  She noted that many of these patients require almost daily transfusions of blood or platelets because of side effects from cancer treatments.

Easing more transitions

The Oncology Evaluation Center also makes it easier for patients to safely go home from the hospital sooner. Providers feel more confident in patients’ safety at home with access to outpatient services that they previously would have needed to stay in the hospital to get. The center offers a backstop, giving oncology teams more flexibility in releasing patients knowing help is available if something comes up.

“Maybe they would have otherwise been a little hesitant to discharge the patient. But, now they know that if something goes wrong they can follow up in this space on a Saturday or Sunday,” said Kucharczuk.

Expanding the Oncology Evaluation Center was also important as a support for a growing number of patients receiving CAR T cell therapy in outpatient settings. These patients schedule appointments in the first month after their therapy infusion for regular toxicity check-ins. They also have an open line to the center in case of urgent needs following the therapy. And, if needed, the center’s staff can directly admit these patients to the hospital. That makes a big difference for patients within a certain radius of the hospital, Kucharczuk noted, because patients with milder side effects not only avoid a long hospital stay, but get to remain closer to family and friends during treatment.

Giving cancer patients more control over their time outside of treatment—and simply more time in general—is one of the center’s notable benefits. The center, and its expanded hours, are an example of Penn Medicine’s efforts underway to ease “time toxicity” for patients. Time toxicity is a concept that takes into consideration all the effort that goes into managing care for a disease, from picking up prescriptions, to calling to arrange appointments and work through insurance tangles, to dealing with traffic, to sitting in waiting rooms.

“Expanded OEC availability will go a long way to ease these often-overlooked burdens for both clinicians and patients,” said Ronac Mamtani, MD, an associate professor of Hematology-Oncology at the Perelman School of Medicine, who leads research on programs to address time toxicity for cancer patients.

Mamtani is Amy Darragh’s oncologist. She says the timing of when some of her most difficult symptoms presented fed her feelings about cancer treatment. Learning about the Oncology Evaluation Center during her first chemotherapy infusion meant that she could immediately worry a lot less about her body’s proclivities toward Friday night complications in the future.