Admission of critically ill patients with cancer to the ICU: many uncertainties remain

Koutsoukou, Antonia

doi:10.1136/esmoopen-2016-000105

Cited by 19 publications

(12 citation statements)

References 34 publications

(41 reference statements)

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“…Those studies might also raise issues as to whether it is futile to admit patients with cancer and COVID-19 to the ICU. 43 On the other hand, other studies suggested that there was no evidence of elevated mortality rates among infected patients with cancer. 24 , 44 An interesting theory even suggested that immunocompromised patients, such as patients with cancer, may dampen the so-called “cytokine storm” because of downregulated immune response and thus have comparable or even better clinical outcomes.…”

Section: Discussionmentioning

confidence: 97%

Effect of Cancer on Clinical Outcomes of Patients With COVID-19: A Meta-Analysis of Patient Data

Giannakoulis

Papoutsi

Siempos

2020

JCO Global Oncology

193

192

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PURPOSE Whether cancer is associated with worse prognosis among patients with COVID-19 is unknown. We aimed to quantify the effect (if any) of the presence as opposed to absence of cancer on important clinical outcomes of patients with COVID-19 by carrying out a systematic review and meta-analysis. METHODS We systematically searched PubMed, medRxiv, COVID-19 Open Research Dataset (CORD-19), and references of relevant articles up to April 27, 2020, to identify observational studies comparing patients with versus without cancer infected with COVID-19 and to report on mortality and/or need for admission to the intensive care unit (ICU). We calculated pooled risk ratios (RR) and 95% CIs with a random-effects model. The meta-analysis was registered with PROSPERO (CRD42020181531). RESULTS A total of 32 studies involving 46,499 patients (1,776 patients with cancer) with COVID-19 from Asia, Europe, and the United States were included. All-cause mortality was higher in patients with versus those without cancer (2,034 deaths; RR, 1.66; 95% CI, 1.33 to 2.07; P < .0001; 8 studies with 37,807 patients). The need for ICU admission was also more likely in patients with versus without cancer (3,220 events; RR, 1.56; 95% CI, 1.31 to 1.87; P < .0001; 26 studies with 15,375 patients). However, in a prespecified subgroup analysis of patients > 65 years of age, all-cause mortality was comparable between those with versus without cancer (915 deaths; RR, 1.06; 95% CI, 0.79 to 1.41; P = .71; 8 studies with 5,438 patients). CONCLUSION The synthesized evidence suggests that cancer is associated with worse clinical outcomes among patients with COVID-19. However, elderly patients with cancer may not be at increased risk of death when infected with COVID-19. These findings may inform discussions of clinicians with patients about prognosis and may guide health policies.

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Section: Discussionmentioning

confidence: 97%

Effect of Cancer on Clinical Outcomes of Patients With COVID-19: A Meta-Analysis of Patient Data

Giannakoulis

Papoutsi

Siempos

2020

JCO Global Oncology

193

192

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“…In contrast with findings of this report, several other studies conducted throughout these months of pandemic failed to reveal higher mortality rates among cancer patients with COVID-19. (27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40) Data presented in this report suggest clinicians should approach cancer patients with ECOG performance status of two or higher as an extremely vulnerable population, which should be a major target of social isolation measures.…”

Section: ❚ Discussionmentioning

confidence: 99%

High mortality among patients with cancer and COVID-19 infection: the experience of a Brazilian cancer center

Barros¹,

Filho

Alves³

et al. 2021

Einstein (São Paulo)

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Objective To evaluate the severity of COVID-19 in cancer patients to describe clinical and epidemiological factors associated with poor outcomes (mortality and need of intensive care unit admission or mechanical ventilation). Methods Retrospective data from patients with cancer and laboratory diagnosis of COVID-19, obtained between March 16 and May 29, 2020, were retrieved out of a cancer center database. Data analyzed included patient history, age, sex, comorbidities, types of cancer and anticancer therapy. Results This sample comprised 105 patients aged 18-92 years, 80.9% of whom were females. Dyspnea was the most prevalent initial symptom (30.4%) among patients who died (p<0.0001). Overall, 57.1% of patients had metastatic disease and 60% had poor performance status (Eastern Cooperative Oncologic Group ≥2) at the time of COVID-19 diagnosis. The overall mortality rate was 40.95%. Mortality rates were higher in male patients and those with poor performance status (p<0.0001). Conclusion This cohort is one of the largest Brazilian studies describing clinical and epidemiological features of patients with cancer and concurrent COVID-19. Findings of this study emphasize the vulnerability of cancer patients in the current pandemic, and indicate high mortality from COVID-19 among male cancer patients and cancer patients with poor performance status. This analysis may assist the selection of patients who may benefit from strict isolation and eventual discontinuation of anticancer therapy to reduce exposure to infection.

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“…This approach is characterized by numerous limitations in terms of clarifying the criteria for treatment continuation or appropriate ICU utilization, as well as precise indications for ICU admission. 14 Further investigation of longterm outcomes is warranted to reduce the uncertainty in critically ill patients.…”

Section: Introductionmentioning

confidence: 99%

A Comprehensive Analysis of 5-Year Outcomes in Patients with Cancer Admitted to Intensive Care Units

et al. 2022

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Background:The aim of this study was to evaluate the long-term (5 years) clinical outcomes of patients who received intensive care unit (ICU) treatment using the Korean nationwide data. Methods:All patients aged >18 years with ICU admission, according to the Korean claims data from January 2008 to December 2010, were enrolled. The enrolled patients were followed up until December 2015. The primary outcome was ICU mortality.Results: Among all critically ill patients admitted to the ICU (n = 323,765), patients with cancer showed higher ICU mortality (18.6%) than those without cancer (13.2%). There was no difference in ICU mortality at day 28 among patients without cancer (14.5%) and those with cancer which was not lung cancer or hematologic malignancies (14.3%). Hazard ratios for the ICU mortality at 5 years were: 1.90 (1.87-1.94) for lung cancer; 1. 44 (1.43-1.46) for other solid cancers; and 3.05 (2.95-3.16) for hematologic malignancies, versus patients without cancer. Conclusions:This study shows that the long-term survival rate of patients with cancer was significantly worse than that of general critically ill patients. However, short term outcomes of critically ill patients with cancer were not significantly different from those of general patients, except for cases with lung cancer and hematologic malignancies.

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Admission of critically ill patients with cancer to the ICU: many uncertainties remain

Cited by 19 publications

References 34 publications

Effect of Cancer on Clinical Outcomes of Patients With COVID-19: A Meta-Analysis of Patient Data

Effect of Cancer on Clinical Outcomes of Patients With COVID-19: A Meta-Analysis of Patient Data

High mortality among patients with cancer and COVID-19 infection: the experience of a Brazilian cancer center

A Comprehensive Analysis of 5-Year Outcomes in Patients with Cancer Admitted to Intensive Care Units

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