Impact of life-sustaining therapies on critically ill patients with cancer.

Abstract

e13590 Background: Advances in diagnosis and treatment have led to large reductions in mortality rates for patients with cancer, resulting in a steady increase in patients admitted to intensive care units (ICUs). However, there is conflicting evidence supporting the benefit of common life-sustaining therapies for critically ill patients, within this cohort. We examined differences in treatment effects of life-sustaining therapies between critically ill septic patients with and without cancer. Methods: Adults aged 18+ with a principal cancer diagnosis from 2008 - 2019, admitted to the ICU for sepsis, were extracted from publicly accessible ICU databases: Medical Information Mart for Intensive Care IV (MIMIC-IV) and the eICU Collaborative Research Database (eICU-CRD). Logistic regression estimated the likelihood of receiving mechanical ventilation (MV), renal replacement therapy (RRT) or vasopressors (VP) during ICU admission. Additionally targeted maximum likelihood estimation (TMLE) models estimated average treatment effects of MV, VP, and RRT on mortality. As TMLE uses machine learning models, it accommodates large numbers of covariates with complex, non-linear relationships. The method outputs Average treatment effect (ATE), an odds ratio representing the mean difference in outcomes in a hypothetical world in which all patients received treatment, compared to a hypothetical world in which no patients received treatment. Models were adjusted for age, sex, ethnicity, Charlson Comorbidity Index, SOFA score, hypertension, heart failure, asthma, COPD, CKD, and code status at admission. Results: A total of 7,120 adults met inclusion criteria. Septic patients with cancer did not have a significantly different likelihood of receiving MV (aOR [95%CI], 0.94 [0.6 - 1.46]), RRT (0.79, [0.33 - 1.93]), or VP (1.09, [0.74, 1.9]) than septic patients without cancer. Among patients with low SOFA scores, those with cancer were more likely than those without cancer to benefit from RRT. Otherwise, there was no statistically significant difference in mortality with the use of MV, RRT, and VP between patients with and without cancer (p>0.05). Conclusions: To our knowledge this is the first study to utilize contemporary, nationwide critical care data to establish a causal relationship between mortality and the use of common life-sustaining therapies for patients with cancer. Our study highlights the tremendous advances in cancer treatment over the last decade, leading to similar effects of common critical care interventions on mortality, regardless of cancer diagnosis. [Table: see text]