Mortality of Adult Patients With Cancer Admitted to an Intensive Care Unit in Chile: A Prospective Cohort Study

Abstract

Purpose Increasing numbers of reports have shown acceptable short-term mortality of patients with cancer admitted into the intensive care unit (ICU). The aim of this study was to determine the mortality of critically ill patients with cancer admitted to the ICU in a general hospital in Chile. Materials and Methods This was a prospective cohort trial in which we included all patients with cancer admitted to the ICU between July 2015 and September 2016. Demographic, physiologic, and treatment data were registered, and survival at 30 days and 6 months was evaluated. A prespecified subgroup analysis considering the admission policy was performed. These subgroups were (1) ICU admission for full code management and (2) ICU trial (IT). Results During the study period, 109 patients with cancer were included. Seventy-nine patients were considered in the full code management group and 30 in the IT. The mean age of patients was 60 years (standard deviation [SD], 15), and 56% were male. Lymphoma was the most frequent malignancy (17%), and 59% had not received cancer treatment because of a recent diagnosis. The mean Acute Physiology and Chronic Health Evaluation and Sequential-Related Organ Failure Assessment scores were 22.2 (SD, 7.3) and 7 (SD, 3), respectively. There were no differences in vasopressor, fluid, or transfusion requirements between subgroups. Lactate levels, Sequential-Related Organ Failure Assessment scores (day 1, 3, and 5), complications, and ICU length of stay were similar. In the entire cohort, 30-day and 6-month mortality was 47% and 66%, respectively. There was no difference in mortality between subgroups according to the admission policy. Conclusion Patients admitted to the ICU in a developing country are at high risk for short-term mortality. However, there is a relevant subgroup that achieves 6-month survival, even among patients who undergo an IT.

Survival of Critically Ill Oncologic Patients Requiring Invasive Ventilatory Support: A Prospective Comparative Cohort Study With Nononcologic Patients

“…However, our data differ from data previously reported from Chile. In fact, in the study by Panay et al, 21 hematologic malignancies were over-represented, and 62% of the overall cohort was supported by IMV. Therefore, these Chilean studies are not comparable, but may be complementary.…”

Practical Considerations for Treating Patients With Cancer in the COVID-19 Pandemic

“…Oncologists also need to recognize that patients with metastatic solid organ malignancies have poor survival outcomes after intensive care unit admission, with studies defining predictors as lung cancer (although in the preimmunotherapy era), extent of systemic disease, need for invasive mechanical ventilation, or renal replacement therapy or vasopressor support. [33][34][35][36] The COVID-19 pandemic is unprecedented in our lifetime, and we are likely to have to make difficult and distressing decisions. It is incumbent on us as an oncology community Port flushes can be reduced to every 8-10 weeks in situations of resource limitation.…”

Management of cancer patients during COVID-19 pandemic at developing countries

“…It has been proven that patients with even advanced stage of cancer who have control over their disease through oncological treatment, i.e ., having stable disease or partial/complete response as well as acute medical morbidities have a similar prognosis as patients without cancer and admitted to the ICU[ 15 ]. There have been multiple reports about the survival of cancer patients hospitalised in the ICU[ 16 - 19 ]. The change in the prognosis of cancer patients and the improvement of their prognosis after critical care hospitalisation opens the challenging scenario of evaluating the risk-benefit balance of advanced life support and prioritisation of medical resources, especially in a complex scenario as a pandemic.…”