Outcomes of Critically Ill Cancer Patients in a University Hospital Setting

Abstract

Critically ill cancer patients constitute a large percentage of admissions to tertiary care medical intensive care units (ICUs). We sought to describe outcomes of such patients, and to evaluate how conditions commonly seen in these patients impact mortality. A total of 348 consecutive medical ICU cancer patients were evaluated. Subgroup comparisons included the three most common cancer types (leukemia, lymphoma, lung cancer), as well as three different treatments/conditions (bone marrow transplant [BMT] versus non-BMT, mechanical ventilation [MV] versus non-MV, neutropenic versus non-neutropenic). There were no mortality differences between patients with leukemia, lymphoma, or lung cancer. By logistic regression, mortality predictors were: MV, hepatic failure, and cardiovascular failure for the group as a whole (41% overall mortality); MV and allogeneic (as compared with autologous) BMT for the BMT group (39% overall mortality); hepatic failure, cardiovascular failure, and persistent acute respiratory distress syndrome (ARDS) for the MV group (67% overall mortality); and MV for the neutropenic group (53% overall mortality). Neutropenia showed no independent association with mortality in the group as a whole or any subgroup analyzed. We conclude that respiratory, hepatic, and cardiovascular failure predict mortality, whereas neutropenia does not. Additionally, we have noted an encouraging improvement in survival in many groups of critically ill cancer patients.

Rate and patterns of ICU admission among colorectal cancer patients: a single-center experience

“…According to the literature, during their hospitalization, survival of cancer patients admitted to the intensive care unit is mainly influenced by the physiological disturbances caused by the complications leading to ICU admission [10,14,17]. We confirmed these observations in the present study, highlighting in particular the SOFA score, but also easily measurable variables like fever and GOT.…”

“…The same low percentage of ICU admissions (3 %) of patients with colorectal cancer was found in a study dealing with both solid and hematological tumors [14]. The frequency of digestive cancers among solid tumors admitted in ICU is between 7 and 17 % in other series [10,15].…”

“…It is interesting to note that causes of admission patterns differed from those of patients with other cancer types. While, in other studies, hemodynamic problems represented a major cause of admission to the ICU among all cancer types [14], respiratory problems were also very common in patients with hematologic [5] or pulmonary neoplasia [6,7]. The causes of admission for digestive reasons are more specific to patients with colorectal cancer.…”

The Therapeutic Outcomes of Mechanical Ventilation in Hematological Malignancy Patients with Respiratory Failure

“…Although NPPV also appears to be useful in the initial stage of acute respiratory failure, treatment with NPPV alone was unsuccessful in the majority of cases, and the failure of the initial NPPV treatment may be associated with a prognosis (14). The above results appear to indicate a need for stringent monitoring to ensure that there is no delay in the progression from NPPV to IMV, and that an ICU is a preferable treatment environment to a sterile ward (17).…”

Outcome in critically ill cancer patients: past and present

“…The high mortality of more than 80% in patients requiring mechanical ventilation (Table 1) [8][9][10][11][12][13][14][15] , increasing to more than 90% to 95% in patients developing multiple organ failure or who require renal replacement therapy during ICU stay 12,[16][17][18] , particularly in the transplant setting [19][20][21] , together with the severe emotional burden endured by these patients and their relatives, and the considerable costs of advanced and prolonged life-supporting therapy 13 resulted in a general reluctance to admit such patients to the ICU 2,6,7 . However, over the past few years, several centres throughout the world have been reporting on increasingly improving survival in critically ill patients with hematological malignancies and solid tumors [22][23][24][25][26][27][28][29][30][31] , approaching survival rates reported in general ICU patients 32 . In a case-historical control study 22 , Azoulay et al reported a four-fold lower risk of death in cancer patients who required mechanical ventilation between 1996 and 1998 as compared with 1990-1995.…”