Abstract
One among seven women will present with breast cancer for which major therapeutic advances led to a significant increase in survival and cure rates. During or after cancer treatment, severe complications may occur requiring admission in intensive care unit (ICU). Intensivists could be reluctant for accepting cancer patients in the ICU, and there are very few data about causes of admission and prognosis of patients with breast cancer admitted in the ICU for an acute complication. Our study seeks to determine, in a population of patients with breast cancer, the main causes for ICU admission and the predictors of death during hospital stay and prognostic factors for survival after hospital discharge. This retrospective study includes all unplanned ICU admissions of patients with breast cancer in a cancer hospital from January 1, 2009 to December 31, 2014. To search for predictive factors of death during hospitalization, Mann-Whitney or Fisher Exact (or chi-square) tests were used for continuous variables or categorical variables, respectively. A logistic regression model was applied for multivariate analysis. Multivariate analysis of prognostic factors for survival after hospital discharge was performed with a Cox's proportional hazards model. Of 1586 ICU admissions during the study period, 282 (18%) concerned breast cancer of which 175 met the inclusion criteria. The main causes of admission were of cardiovascular (26%), respiratory (19%), neurologic (19%), or infectious (14%) origin. ICU death rate was 15% and, overall, 28% of the patients died during hospitalization. The median survival time after hospitalization was 12.8 months (95% CI: 8.2-20.7). Independent predictors of death during hospitalization were the sequential organ failure assessment (SOFA) score (OR 1.36, 95% CI 1.15-1.60), high GPT values (OR 3.70, 95% CI: 1.52-9.03), and cardiovascular disease (OR 0.23, 95% CI: 0.06-0.86). Independent predictors of death after hospital discharge were metastatic disease (HR 7.90, 95% CI 3.69-16.92), high GOT value (HR 3.22 95% CI: 1.93-5.36), simplified acute physiology score (SAPS) (HR 1.95 95% CI: 1.21-3.16), and therapeutic limitations during the first 24 h after ICU admission (HR 8.52 95% CI: 3.66-19.87). Independent predictors of death during hospitalization were related to the acute complications (SOFA score, GPT level and cardiovascular-related admission) while cancer parameters retained their prognostic significance for survival after hospital discharge (metastatic disease, therapeutic limitations).
Highlights
In Europe, approximately one in seven patients admitted to an intensive care unit (ICU) are presenting with a cancer, mainly solid tumors [1]
All admissions were considered for the description of causes of ICU admission but only the first stay in the ICU was considered for hospital mortality and survival after discharge analyses
We found three statistically independent predictors of death during hospitalization: SOFA score, and GPT above the median value as predictive factors of poor outcome, while cardiovascular disease as cause of the admission being a predictive factor of better outcome (Table 5)
Summary
In Europe, approximately one in seven patients admitted to an intensive care unit (ICU) are presenting with a cancer, mainly solid tumors [1]. Cancer characteristics recovered all their importance for further prognosis only after hospital discharge. In this setting, a discussion between the intensivist and the treating oncologist is of particular importance. A discussion between the intensivist and the treating oncologist is of particular importance Both have to integrate the therapeutic option, and the possibility of cancer control as well as the prognosis linked to the acute complication before admitting in the ICU and/or determining the potential limits of the critical management
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