Outcomes in Critically Ill Patients with Cancer-Related Complications

Abstract

IntroductionCancer patients are at risk for severe complications related to the underlying malignancy or its treatment and, therefore, usually require admission to intensive care units (ICU). Here, we evaluated the clinical characteristics and outcomes in this subgroup of patients.Materials and MethodsSecondary analysis of two prospective cohorts of cancer patients admitted to ICUs. We used multivariable logistic regression to identify variables associated with hospital mortality.ResultsOut of 2,028 patients, 456 (23%) had cancer-related complications. Compared to those without cancer-related complications, they more frequently had worse performance status (PS) (57% vs 36% with PS≥2), active malignancy (95% vs 58%), need for vasopressors (45% vs 34%), mechanical ventilation (70% vs 51%) and dialysis (12% vs 8%) (P<0.001 for all analyses). ICU (47% vs. 27%) and hospital (63% vs. 38%) mortality rates were also higher in patients with cancer-related complications (P<0.001). Chemo/radiation therapy-induced toxicity (6%), venous thromboembolism (5%), respiratory failure (4%), gastrointestinal involvement (3%) and vena cava syndrome (VCS) (2%) were the most frequent cancer-related complications. In multivariable analysis, the presence of cancer-related complications per se was not associated with mortality [odds ratio (OR) = 1.25 (95% confidence interval, 0.94–1.66), P = 0.131]. However, among the individual cancer-related complications, VCS [OR = 3.79 (1.11–12.92), P = 0.033], gastrointestinal involvement [OR = 3.05 (1.57–5.91), P = <0.001] and respiratory failure [OR = 1.96(1.04–3.71), P = 0.038] were independently associated with in-hospital mortality.ConclusionsThe prognostic impact of cancer-related complications was variable. Although some complications were associated with worse outcomes, the presence of an acute cancer-related complication per se should not guide decisions to admit a patient to ICU.

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

“…Despite the fact that patients with metastatic cancer had an indication for being admitted into the intensive care units, it was not so because of their predicted poor prognosis[ 13 ]. The development of new oncology therapies has improved survival in cancer patients, and therefore, increased the probability of developing medical complications requiring admission to the ICU, such as intestinal obstruction, infections, respiratory failure, acute kidney injury, among others, and complications associated with cancer treatment[ 14 ]. 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 ].…”

In-hospital and day-120 survival of critically ill solid cancer patients after discharge of the intensive care units: results of a retrospective multicenter study—A Groupe de recherche respiratoire en réanimation en Onco–Hématologie (Grrr-OH) study

“…In a literature review of adult patients with solid cancers admitted to the ICU from January 2000 to April 2014, Puxty et al [4] identified 48 studies, among which in-ICU mortality was reported in 32 studies, in-hospital mortality reported in 25 studies, and mortality at 1, 3, and 6 months, respectively, reported in only 4, 5, and 7 studies. One of the most obvious reasons is that studies on cancer patients hospitalized in the ICU are still ongoing, and even the most recent ones continue to mix patients with hematological malignancies and those with solid cancers under the generic term “cancer patients” [5, 6]. However, there is evidence for several years that the prognosis of solid cancer patients is totally different depending on the type of cancer, whether hematological or solid [7].…”

Prognostic factors of noninvasive mechanical ventilation in lung cancer patients with acute respiratory failure

“…One of the most frequently encountered complications in critically ill cancer patients is RF[ 6 ]. In cancer patients with RF who require ventilator support, endotracheal intubation with invasive mechanical ventilation (IMV) is the most common treatment modality[ 7 ].…”