Intensive Care Unit Outcomes Among Patients With Lung Cancer in the Surveillance, Epidemiology, and End Results–Medicare Registry

Abstract

A B S T R A C T PurposeLung cancer is the leading cause of cancer-related mortality. Intensive care unit (ICU) use among patients with cancer is increasing, but data regarding ICU outcomes for patients with lung cancer are limited. Patients and MethodsWe used the Surveillance, Epidemiology, and End Results (SEER) -Medicare registry (1992 to 2007) to conduct a retrospective cohort study of patients with lung cancer who were admitted to an ICU for reasons other than surgical resection of their tumor. We used logistic and Cox regression to evaluate associations of patient characteristics and hospital mortality and 6-month mortality, respectively. We calculated adjusted associations for mechanical ventilation receipt with hospital and 6-month mortality. ResultsOf the 49,373 patients with lung cancer admitted to an ICU for reasons other than surgical resection, 76% of patients survived the hospitalization, and 35% of patients were alive 6 months after discharge. Receipt of mechanical ventilation was associated with increased hospital mortality (adjusted odds ratio, 6.95; 95% CI, 6.89 to 7.01; P Ͻ .001), and only 15% of these patients were alive 6 months after discharge. Of all ICU patients with lung cancer, the percentage of patients who survived 6 months from discharge was 36% for patients diagnosed in 1992 and 32% for patients diagnosed in 2005, whereas it was 16% and 11% for patients who received mechanical ventilation, respectively. ConclusionMost patients with lung cancer enrolled in Medicare who are admitted to an ICU die within 6 months of admission. To improve patient-centered care, these results should guide shared decision making between patients with lung cancer and their clinicians before an ICU admission.

The importance of lung cancer in intensive care mortality, a retrospective mortality assessment

“…It also constitutes a significant proportion in the ICU mortality. Previous studies showed poor outcomes in lung cancer patients admitted to the ICU and most notably those requiring mechanical ventilation (11)(12)(13)(14).…”

Aggressiveness of Intensive Care Use Among Patients With Lung Cancer in the Surveillance, Epidemiology, and End Results-Medicare Registry

“…2 Briefl y, patients were eligible if they had received a diagnosis of lung cancer between 1992 and 2005 (n 5 324,509) and they were also enrolled in Medicare during that time. We excluded (1) patients whose lung cancer was diagnosed at autopsy or on a death certifi cate only (n 5 7,650), (2) those with an in situ stage (n 5 195), (3) patients younger than 66 years old at the time of diagnosis (n 5 56,048), (4) those who were eligible for Medicare benefi ts because of disability (n 5 25,078), and (5) those enrolled in Medicare-managed care plans between 1 year prior to and 5 years aft er a lung cancer diagnosis (n 5 59,629) because these patients may have incomplete claims, and are, typically, excluded in studies using Medicare claims.…”

“…1,2 Despite signifi cant advancements in the treatment of lung cancer and in the care of critically ill patients over the last 15 years, these survival statistics remain unchanged. 2 When confronting the end of life, the vast majority of patients with lung cancer would rather forego aggressive nonpalliative care, stating that they would prefer to die at home.…”

“…1,2 Despite signifi cant advancements in the treatment of lung cancer and in the care of critically ill patients over the last 15 years, these survival statistics remain unchanged. 2 When confronting the end of life, the vast majority of patients with lung cancer would rather forego aggressive nonpalliative care, stating that they would prefer to die at home. 3,4 Some estimates, however, suggest that up to one in four patients with lung cancer will be hospitalized in the ICU prior to death, a fi nding not consistent with the wish to avert aggressive nonpalliative care.…”

“…On the one hand, the aggressiveness of nonpalliative care may be increasing over time, as refl ected by greater use of mechanical ventilation (MV), a therapy associated with close to 90% mortality within 6 months. 2,5 On the other hand, growth in palliative and hospice care may have increased the rates of death at home and reduced the use of MV among ICU admissions, or at least limited the use of the ICU to patients with a better prognosis. 8,9 Less aggressive nonpalliative critical care may also be refl ected by changes in the type of ICU to which patients are being admitted.…”