Outcome analyses after the first admission to an intensive care unit in patients with cancer enrolled into a phase I clinical trials program: When is the optimal time to trigger code status discussion?

Abstract

e13020 Background: This study assesses outcomes and prognostic variables of 212 patients with advanced cancer admitted to the intensive care unit (ICU) after becoming patients in the Phase I clinic at MD Anderson Cancer Center. Methods: Outcome analyses were conducted on 212 consecutive patients admitted to the MD Anderson Cancer Center ICU after being seen in the Phase I clinic starting on May 1, 2007. All data were obtained by review of patient electronic medical records. Results: The median survival of 212 Phase I cancer patients after the initial ICU admission was 3.2 weeks (95% CI: 2.5 – 4.9). Those who underwent cardiopulmonary resuscitation (CPR) succumbed within a median of 0.4 weeks. In multivariate analysis, patients who were admitted for surgical intervention did better than those admitted for medical intervention (median survival of 21.5 weeks versus 2.1 weeks, p < 0.0001). Conclusions: Phase I cancer patient outcomes after initial ICU admission for critical care were dismal, particularly when not for surgical intervention and/or when CPR was needed. Most, if not all, of these patients should be encouraged to have out-of-hospital DNR (do not resuscitate) orders.