Do Elderly Patients With Non-hematologic Malignancies Have A Worse Outcome in the ICU?

Abstract

The aim of this study was to evaluate the difference in outcome between older (≥ 65 years) and younger (< 65 years) cancer patients admitted to the intensive care unit (ICU) with acute life-threatening illness. A total of 1,881 patients were admitted to the medical intensive care unit (ICU) of Mackay Memorial Hospital, Taipei, from September 2004 to September 2007. We excluded patients diagnosed with cancer and in remission for > 5 years, ICU stay of < 24 hours, and ICU admission for routine postoperative monitoring. A total of 85 patients were included and divided into younger (< 65 years) and older (≥ 65 years) groups for comparison. The mean ages of the younger and older group were 50.7 ± 3.6 years and 76.1 ± 1.9 years, respectively. There was no significance in ICU length of stay (8.6 ± 2.5 days vs. 11.7 ± 2.6 days; p = 0.09), in the proportion of high Adult Comorbidity Evaluation 27 grade (86.1% vs. 77.6%; p = 0.32). The most frequent reasons for ICU admission in the younger and older groups were acute respiratory failure (50.0% vs. 61.2%) and shock (41.7% vs. 24.5%). The elderly had significantly more sepsis (87.8% vs. 58.3%; p = 0.002) and bloodstream or intraperitoneal infection (34.7% vs. 13.9%; p = 0.03), and received earlier conventional mechanical ventilation (−0.3 ± 0.17 days vs. 0.13 ± 0.36 days; p = 0.045) and shorter vasopressor administration (2.07 ± 0.94 days vs. 5.36 ± 2.63 days; p = 0.03). The hospital survival times in younger and older groups were 36.3 ± 16.3 days and 60.9 ± 33.9 days ( p = 0.20), respectively, and 1-year survival rates were 2.8% and 12.2% ( p = 0.12), respectively. The main cause of death and survival rates, both short-term and long-term, were not worse in elderly patients with non-hematologic malignancies in the ICU, and the main reasons for patient death were sepsis and respiratory failure, rather than the malignancy itself. Therefore, an ICU admission policy should not exclude elderly patients with non-hematologic malignancies merely because of concerns about survival rate or life expectancy.