Characteristics and outcomes of patients with hematologic malignancies receiving chemotherapy in the intensive care unit

Pastores, Stephen M.; Goldman, Debra A.; Shaz, David; Kostelecky, Natalie; Daley, Ryan J.; Peterson, Tim J; Tan, Kay See; Halpern, Neil A.

doi:10.1002/cncr.31409

Cited by 13 publications

(13 citation statements)

References 32 publications

(66 reference statements)

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“…Although our data did not capture remission status of the included patients, we found that active malignancy treatment in the form of chemotherapy and/or radiation is associated with a lower risk of in-hospital mortality among hematologic oncology patients. Following ICU admission, ongoing chemotherapy has been associated with longer length of hospital and ICU stays, but mortality in these patients is similar to those who do not receive chemotherapy [50]. In our study, the association between active treatment and reduced mortality may be influenced by residual confounding, as those who receive active treatment may be healthier and may therefore experience more favorable outcomes following ICU admission.…”

Section: Discussionmentioning

confidence: 75%

Outcomes of hospitalized hematologic oncology patients receiving rapid response system activation for acute deterioration

et al. 2019

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Background Patients with hematologic malignancies who are admitted to hospital are at increased risk of deterioration and death. Rapid response systems (RRSs) respond to hospitalized patients who clinically deteriorate. We sought to describe the characteristics and outcomes of hematologic oncology inpatients requiring rapid response system (RRS) activation, and to determine the prognostic accuracy of the SIRS and qSOFA criteria for in-hospital mortality of hematologic oncology patients with suspected infection. Methods We used registry data from two hospitals within The Ottawa Hospital network, between 2012 and 2016. Consecutive hematologic oncology inpatients who experienced activation of the RRS were included in the study. Data was gathered at the time of RRS activation and assessment. The primary outcome was in-hospital mortality. Logistical regression was used to evaluate for predictors of in-hospital mortality. Results We included 401 patients during the study period. In-hospital mortality for all included patients was 41.9% (168 patients), and 145 patients (45%) were admitted to ICU following RRS activation. Among patients with suspected infection at the time of RRS activation, Systemic Inflammatory Response Syndrome (SIRS) criteria had a sensitivity of 86.9% (95% CI 80.9–91.6) and a specificity of 38.2% (95% CI 31.9–44.8) for predicting in-hospital mortality, while Quick Sequential Organ Failure Assessment (qSOFA) criteria had a sensitivity of 61.9% (95% CI 54.1–69.3) and a specificity of 91.4% (95% CI 87.1–94.7). Factors associated with increased in-hospital mortality included transfer to ICU after RRS activation (adjusted odds ratio [OR] 3.56, 95% CI 2.12–5.97) and a higher number of RRS activations (OR 2.45, 95% CI 1.63–3.69). Factors associated with improved survival included active malignancy treatment at the time of RRS activation (OR 0.54, 95% CI 0.34–0.86) and longer hospital length of stay (OR 0.78, 95% CI 0.70–0.87). Conclusions Hematologic oncology inpatients requiring RRS activation have high rates of subsequent ICU admission and mortality. ICU admission and higher number of RRS activations are associated with increased risk of death, while active cancer treatment and longer hospital stay are associated with lower risk of mortality. Clinicians should consider these factors in risk-stratifying these patients during RRS assessment. Electronic supplementary material The online version of this article (10.1186/s13054-019-2568-5) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 75%

Outcomes of hospitalized hematologic oncology patients receiving rapid response system activation for acute deterioration

et al. 2019

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“…Our study also confirms that oncologic emergencies remain the most frequent reason for initiation oncologic therapies for patients with hematologic malignancies. 2,4,5…”

Section: Discussionmentioning

confidence: 99%

“…We have previously described the background methods for this study. 5,6 In brief, using hospital-wide and ICU databases, we identified all ICU patients with cancer who received oncologic therapies. We included for analysis only the first ICU admission during which the patient received oncologic therapies.…”

Section: Methodsmentioning

confidence: 99%

Analysis of Intent and Reason for Oncologic Therapy Administration in Cancer Patients Admitted to the Intensive Care Unit

Shaz

Pastores

Dayal

et al. 2021

J Intensive Care Med

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Purpose To investigate the intent of, and reason for, administration of oncologic therapies in the intensive care unit (ICU). Methods Single center, retrospective, cohort study of patients with cancer who received oncologic therapies at a tertiary cancer center ICU between April 1, 2019 and March 31, 2020. Oncologic therapies included traditional cytotoxic chemotherapy, targeted therapy, immunotherapy, hormonal or biologic therapy directed at a malignancy and were characterized as initiation (initial administration) or continuation (part of an ongoing regimen). Results 84 unique patients (6.8% of total ICU admissions) received oncologic therapies in the ICU; 43 (51%) had hematologic malignancies and 41 (49%) had solid tumors. The intent of oncologic therapy was palliative in 63% and curative in 27%. Twenty-two (26%) patients received initiation and 62 (74%) received continuation oncologic therapies. The intent of oncologic therapy was significantly different by regimen type (initiation vs. continuation, p = <0.0001). Initiation therapy was more commonly prescribed with curative intent and continuation therapy was more commonly administered with palliative intent (p = <0.0001). Oncologic therapies were given in the ICU mainly for an oncologic emergency (56%) and because the patients happened to be in the ICU for a non-oncologic critical illness when their oncologic therapy was due (34.5%). Conclusion Our study provides intensivists with a better understanding of the context and intent of oncologic therapies and why these therapies are administered in the ICU.

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“…Lung cancer and acute respiratory failure due to airway compression or pulmonary infiltrates may explain the high mortality rates[ 182 - 184 ]. In patients with hematological malignancy 25%-40% die in the ICU; 30-d, 6-mo and 1-year mortality rates is 40%, 51%-77% and 50%, respectively[ 10 , 185 ]. Risk factors for mortality are degree of organ dysfunction and life-support methods such as ventilatory support, vasopressors, and renal replacement therapy.…”

Section: Chemotherapy In Icumentioning

confidence: 99%

Critically ill patients with cancer: A clinical perspective

Martos-Benítez

Soler-Morejón

Lara-Ponce

et al. 2020

WJCO

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Cancer patients account for 15% of all admissions to intensive care unit (ICU) and 5% will experience a critical illness resulting in ICU admission. Mortality rates have decreased during the last decades because of new anticancer therapies and advanced organ support methods. Since early critical care and organ support is associated with improved survival, timely identification of the onset of clinical signs indicating critical illness is crucial to avoid delaying. This article focused on relevant and current information on epidemiology, diagnosis, and treatment of the main clinical disorders experienced by critically ill cancer patients.

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Characteristics and outcomes of patients with hematologic malignancies receiving chemotherapy in the intensive care unit

Cited by 13 publications

References 32 publications

Outcomes of hospitalized hematologic oncology patients receiving rapid response system activation for acute deterioration

Outcomes of hospitalized hematologic oncology patients receiving rapid response system activation for acute deterioration

Analysis of Intent and Reason for Oncologic Therapy Administration in Cancer Patients Admitted to the Intensive Care Unit

Critically ill patients with cancer: A clinical perspective

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