Impact of two different comorbidity measures on the 6-month mortality of critically ill cancer patients

Abstract

Severe comorbidities must be considered in the outcome evaluation of ICU cancer patients. The ACE-27 seems to be a useful instrument for prognostic assessment in this population.

Outcomes of haematology/oncology patients admitted to intensive care unit at The Canberra Hospital

“…Comorbidities have been shown to influence the prognosis, risk of complications and response to chemotherapy in patients with malignancy but available data about the impact of comorbidities on the prognosis of critically ill patients with cancer are scant. A single prospective cohort study showed that 50% of the cancer patients admitted to ICU had associated severe comorbidities evaluated by the adult comorbidity evaluation‐27; this was shown to be independently associated with 6‐month mortality . Although our assessment of comorbidities was limited by the retrospective nature of the data, we did not find that an increasing number of comorbidities impacted on short‐term outcome.…”

“…Intensive care is a costly and limited resource; therefore, it is important that patients referred for admission are triaged appropriately so that those selected have a reasonable likelihood of benefit. Guidelines for triaging and selecting oncology patients have been developed, based largely on retrospective data showing poor outcomes in patients with certain prognostic factors such as increasing age, previous bone marrow transplantation, evidence of neutropenia, the need for mechanical ventilation or dialysis, presence of severe sepsis and progressive malignant disease . However, studies have shown improved outcomes in critically ill cancer patients in many of these settings, thus throwing into question the validity and reliability of these factors as prognostic tools …”

Survival Following Radiation and Androgen Suppression Therapy for Prostate Cancer in Healthy Older Men: Implications for Screening Recommendations

“…using the Adult Comorbidity Evaluation 27 (ACE-27), a 27-item validated comorbidity index for use in patients with cancer (3,7). The ACE-27 instrument was selected because the clinically relevant comorbid ailments used to obtain the comorbidity score were selected on the basis of prior research by experts.…”

Characteristics and outcomes of oncology unit patients requiring admission to an Australian intensive care unit

“…However, regardless of the specific prognostic score used, this strengthens the evidence that the decision to admit a patient to the ICU should focus on the probability of surviving the acute illness . Medical comorbidities with ACE‐27 score also correlated with 6‐month mortality, consistent with previous studies . This emphasises the importance of patient selection in the context of other baseline organ dysfunction.…”