Long-term outcomes and quality of life in critically ill patients with hematological or solid malignancies: a single center study

Oeyen, Sandra; Benoît, Dominique; Annemans, Lieven; Depuydt, P; Belle, Simon J. van; Troisi, Roberto; Noens, Lucien; Pattyn, Piet; Decruyenaere, Johan

doi:10.1007/s00134-012-2791-x

Cited by 103 publications

(133 citation statements)

References 37 publications

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“…113 In the ICU setting, few data are available for patients with hematological malignancies. 10,114,115 Studies are warranted to evaluate long-term outcome in allo-HSCT long-term ICU survivors. The place of patient and family wishes and implication in the shared decision-making process also needs to be clearly evaluated.…”

Section: Limitations Of the Published Experiences And Unresolved Issuesmentioning

confidence: 99%

Critically ill allogeneic hematopoietic stem cell transplantation patients in the intensive care unit: reappraisal of actual prognosis

Saillard

Blaise

Mokart

2016

Bone Marrow Transplant

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The outcome of allogeneic hematopoietic stem cell transplantation (allo-HSCT) patients has significantly improved over the past decade. Still, a significant number of patients require intensive care unit (ICU) management because of life-threatening complications. Literature from the 1990s reported extremely poor prognosis for critically ill allo-HSCT patients requiring ICU management. Recent data justify the use of ICU resources in hematologic patients. Yet, allo-HSCT remains an independent variable associated with mortality. However, outcomes in allo-HSCT patients have improved over time and many classic determinants of mortality have become irrelevant. The main actual prognostic factors are the need for mechanical ventilation, the presence of GvHD and the number of organ failures at ICU admission. Recently, the development of reduced-intensity conditioning regimens, early ICU admission and the increased use of noninvasive ventilation, combined with time effect and general advances in hematology, in allo-HSCT procedures and in ICU management have contributed to improve general outcome. A rational policy of ICU admission triage in these patients is very hard to define, as each decision for ICU admission is a case-by-case decision at patient bedside. The collaboration between hematologists and intensivists is crucial in this context.

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Section: Limitations Of the Published Experiences And Unresolved Issuesmentioning

confidence: 99%

Critically ill allogeneic hematopoietic stem cell transplantation patients in the intensive care unit: reappraisal of actual prognosis

Saillard

Blaise

Mokart

2016

Bone Marrow Transplant

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“…A recent multicenter study suggested that the quality of life 90 days after ICU discharge in cancer patients was good and similar to age-and gender-matched cancer patients who did not require ICU admission [5]. In contrast, a previous study of critically ill cancer patients reported a profound alteration in quality of life up to 1 year following ICU admission [16]. The overall long-term survival of cancer patients after ICU discharge also remains largely unknown.…”

mentioning

confidence: 99%

Has survival increased in cancer patients admitted to the ICU? Yes

2014

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Intensive care unit (ICU) admission of patients with cancer has long been controversial. Studies performed in the early 1990s demonstrated high mortality rates in cancer patients admitted to the ICU, especially among those with respiratory failure requiring mechanical ventilation, neutropenic sepsis, and in hematopoietic stem cell transplant (HSCT) recipients [1, 2]. Additionally, a lack of cost-effectiveness was noted and some authors argued that denial of ICU admission could avoid futile care and unwarranted aggressive therapy in dying patients [3, 4].Over the past decade, however, studies that report prognosis and predictive factors for mortality in critically ill cancer patients have shown different results [5][6][7][8][9][10]. Although mortality remains high when compared to the general population of critically ill patients, these studies have demonstrated meaningful ICU and hospital survival rates and some of them improved survival over time [5][6][7][8]. Unadjusted ICU and hospital mortality rates have been found to decrease progressively [9]. However, these findings were mainly reported by single center cohort studies and usually involved a small number of patients [9]. A recent, prospective multicenter study of 1,011 critically ill patients with hematological malignancies [5] reported encouraging hospital, 90-day, and 1-year survival rates of 60.7, 52.5, and 43.3 %, respectively compared with the poor outcomes reported 15-20 years ago [1, 2, 5, 9]. Similarly, although hospital mortality remained high in those patients requiring mechanical ventilation (60.5 %), this mortality rate is significantly lower than the over 90 % mortality rates in mechanically ventilated cancer patients that were earlier reported [1, 2, 5]. Recent studies have also confirmed that complete or partial remission of the underlying disease, lack of comorbidities, and good performance status are associated with increased risk of survival whereas some of the usual prognostic factors such as neutropenia failed to be associated with adverse outcomes [5, 6, 10].Improved survival has also been demonstrated in subgroups of critically ill cancer patients including those with neutropenic sepsis [7], myeloma patients [10], and to a lesser extent in HSCT recipients [11]. Similarly, the outcome of cancer patients admitted to the ICU with severe sepsis or septic shock [6], acute respiratory distress syndrome (ARDS) [8], or those requiring mechanical Intensive Care Med (2014) 40:1570-1572

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“…There has been a very pervasive pessimism and scarcity of data on long-term outcomes after critical illness complicating hematological or solid malignancy. In a prospective, single-center observational study of 483 patients, Oeyen et al [53] assessed HRQoL outcomes at 3 months and 1 year after ICU discharge and compared these outcomes to HRQoL before ICU admission. Median age was 62 years and the majority were men with a solid malignancy.…”

Section: Quality Of Lifementioning

confidence: 99%

Year in review in Intensive Care Medicine 2013: II. Sedation, invasive and noninvasive ventilation, airways, ARDS, ECMO, family satisfaction, end-of-life care, organ donation, informed consent, safety, hematological issues in critically ill patients

et al. 2014

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Long-term outcomes and quality of life in critically ill patients with hematological or solid malignancies: a single center study

Abstract: Long-term outcomes and QOL were poor, particularly in HM. Long-term expectations should play a larger role during multidisciplinary triage decisions upon referral to the ICU.

Cited by 103 publications

References 37 publications

Critically ill allogeneic hematopoietic stem cell transplantation patients in the intensive care unit: reappraisal of actual prognosis

Critically ill allogeneic hematopoietic stem cell transplantation patients in the intensive care unit: reappraisal of actual prognosis

Has survival increased in cancer patients admitted to the ICU? Yes

Year in review in Intensive Care Medicine 2013: II. Sedation, invasive and noninvasive ventilation, airways, ARDS, ECMO, family satisfaction, end-of-life care, organ donation, informed consent, safety, hematological issues in critically ill patients

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