Abstract
BackgroundAt intensive care unit (ICU) admission, the issue about prognosis of critically ill cancer patients is of clinical interest, especially after ICU discharge. Our objective was to assess the factors associated with 3- and 6-month survival of ICU cancer survivors.MethodsBased on the French OutcomeRea™ database, we included solid cancer patients discharged alive, between December 2005 and November 2013, from the medical ICU of the university hospital in Grenoble, France. Patient characteristics and outcome at 3 and 6 months following ICU discharge were extracted from available database.ResultsOf the 361 cancer patients with unscheduled admissions, 253 (70%) were discharged alive from ICU. The main primary cancer sites were digestive (31%) and thoracic (26%). The 3- and 6-month mortality rates were 33 and 41%, respectively. Factors independently associated with 6-month mortality included ECOG performance status (ECOG-PS) of 3–4 (OR,3.74; 95%CI: 1.67–8.37), metastatic disease (OR,2.56; 95%CI: 1.34–4.90), admission for cancer progression (OR,2.31; 95%CI: 1.14–4.68), SAPS II of 45 to 58 (OR,4.19; 95%CI: 1.76–9.97), and treatment limitation decision at ICU admission (OR,4.00; 95%CI: 1.64–9.77). Interestingly, previous cancer chemotherapy prior to ICU admission was independently associated with lower 3-month mortality (OR, 0.38; 95%CI: 0.19–0.75). Among patients with an ECOG-PS 0–1 at admission, 70% (n = 66) and 61% (n = 57) displayed an ECOG-PS 0–2 at 3- and 6-months, respectively. At 3 months, 74 (55%) patients received anticancer treatment, 13 (8%) were given exclusive palliative care.ConclusionsFactors associated with 6-month mortality are almost the same as those known to be associated with ICU mortality. We highlight that most patients recovered an ECOG-PS of 0–2 at 3 and 6 months, in particular those with a good ECOG-PS at ICU admission and could benefit from an anticancer treatment following ICU discharge.
Highlights
At intensive care unit (ICU) admission, the issue about prognosis of critically ill cancer patients is of clinical interest, especially after ICU discharge
Participants in the OUTCOMEREA group have enrolled consecutive patients admitted to ICU, and in others sampling has been performed among all consecutive admissions during a period of time or all admissions to certain ICU beds
Patient characteristics Of the 6608 patients admitted between December 2005 and November 2013 to the Grenoble ICU and recorded into the OutcomeReaTM database, 779 concerned cancer patients (Fig. 1)
Summary
At intensive care unit (ICU) admission, the issue about prognosis of critically ill cancer patients is of clinical interest, especially after ICU discharge. Improving patients’ life expectancy does not exclude their fragility, given that approximately 5–10% of them will develop a life-threatening disease requiring intensive care unit (ICU) admission [4] This is an issue facing intensive care physicians, both in terms of the ICU admission of these patients, as well as their management. The mortality has proven to be largely associated with the general patient condition (Eastern Cooperative Oncology Group performance status [ECOG-PS]) at ICU discharge [10, 21]. This association can be partly explained by the fact that the cancer management strategy is dependent on a patient’s ECOG-PS conditions [22, 23]. The evaluation of the oncologic management pertaining to these patients discharged alive from intensive care has not been fully assessed
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