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Padhi S, Shrestha P, Alamgeer M, Stevanovic A, Karikios D, Rajamani A, Subramaniam A. Oncology and intensive care doctors' perception of intensive care admission of cancer patients: A cross-sectional national survey. Aust Crit Care 2024:S1036-7314(24)00003-1. [PMID: 38350752 DOI: 10.1016/j.aucc.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 12/05/2023] [Accepted: 12/08/2023] [Indexed: 02/15/2024] Open
Abstract
INTRODUCTION Prognosis in oncology has improved with early diagnosis and novel therapies. However, critical illness continues to trigger clinical and ethical dilemmas for the treating oncology and intensive care unit (ICU) doctors. OBJECTIVES The objective of this study was to investigate the perceptions of oncology and ICU doctors in managing critically ill cancer patients. METHODS A cross-sectional web-based survey exploring the management of a fictitious acutely deteriorating case vignette with solid-organ malignancy. The survey weblink was distributed between May and July 2022 to all Australian oncology and ICU doctors via newsletters to the members of the Medical Oncology Group of Australia, the Australian and New Zealand Intensive Care Society, and the College of Intensive Care Medicine inviting them to participate. The weblink was active till August 2022. The six domains included patient prognostication, advanced care plan, collaborative management, legal/ethical/moral challenges, ICU referral, and protocol-based ICU admission. The outcomes were reported as the level of agreement between oncology and ICU doctors for each domain/question. RESULTS 184 responses (64 oncology and 120 ICU doctors) were analysed. Most respondents were specialists (78.1% [n = 50] oncology, 78.3% [n = 94] ICU doctors). Oncology doctors more commonly reported managing cancer patients with poor prognosis than ICU doctors (p < 0.001). Oncology doctors less commonly referred such patients for ICU admission (29.7% [n = 19] vs. 80.8% [n = 97], p < 0.001; odds ratio [OR] = 0.07; 95% confidence interval [CI]: 0.03-0.16) and infrequently encountered patients with prior goals of care (GOC) in medical emergency team escalations (40.6% [n = 26] vs. 86.7% [n = 104]; p < 0.001; OR = 0.06; 95% CI: 0.02-0.15; p < 0.001). Oncology doctors were less likely to discuss GOC during medical emergency team calls or within 24 h of ICU admission. More oncology doctors than ICU doctors thought that training rotation in the corresponding speciality group was beneficial (56.3% [n = 36] vs. 31.7% [n = 38]; p = 0.012; OR = 2.07; 95% CI: 1.02-4.23; p = 0.045). CONCLUSION Oncology doctors were less likely to encounter acute patient deterioration or establish timely GOC for such patients. Oncology doctors believed that an ICU rotation during their training may have helped manage challenging situations.
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Affiliation(s)
- Swarup Padhi
- Department of Intensive Care, Goulburn Valley Health, Shepparton, Victoria, Australia.
| | - Prajwol Shrestha
- Department of Medical Oncology, Calvary Mater Newcastle Hospital, NSW, Australia
| | - Muhammad Alamgeer
- Department of Medical Oncology, Monash Health, Clayton, Victoria, Australia; School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Australia; Centre for Cancer Research, Hudson Institute of Medical Research, Clayton, Australia
| | - Amanda Stevanovic
- Department of Medical Oncology, Nepean Clinical School and Nepean Hospital, Kingswood, NSW, Australia; Sydney Medical School, University of Sydney, NSW, Australia
| | - Deme Karikios
- Department of Medical Oncology, Nepean Clinical School and Nepean Hospital, Kingswood, NSW, Australia; Sydney Medical School, University of Sydney, NSW, Australia
| | - Arvind Rajamani
- Sydney Medical School, University of Sydney, NSW, Australia; Department of Intensive Care, Nepean Clinical School and Nepean Hospital, Kingswood, NSW, Australia
| | - Ashwin Subramaniam
- Department of Intensive Care, Peninsula Health, Frankston, Victoria, Australia; Department of Intensive Care, Monash Health, Dandenong, Victoria, Australia; Peninsula Clinical School, Monash University, Frankston, Victoria, Australia; Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Nadkarni Y, Kukec I, Gruber P, Jhanji S, Droney J. Integrated palliative care: triggers for referral to palliative care in ICU patients. Support Care Cancer 2021; 30:2173-2181. [PMID: 34704155 DOI: 10.1007/s00520-021-06542-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 09/03/2021] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Palliative care within intensive care units (ICU) benefits decision-making, symptom control, and end-of-life care. It has been shown to reduce the length of ICU stay and the use of non-beneficial and unwanted life-sustaining therapies. However, it is often initiated late or not at all. There is increasing evidence to support screening ICU patients using palliative care referral criteria or "triggers". The aim of the project was to assess the need for palliative care referral during ICU admission using "trigger" tools. METHODS Electronic record review of cancer patients who died in or within 30 days of discharge from oncology ICU, between 2016 and 2018. Patients referred to palliative care before or during ICU admission were identified. Three sets of palliative care referral "triggers" were applied: one that is being tested locally and two internationally derived tools. The proportion of patients who met any of these triggers during their final ICU admission was calculated. RESULTS Records of 149 patients were reviewed: median age 65 (range 20-83). Most admissions (89%) were unplanned, with the most common diagnoses being haemato-oncology (31%) and gastrointestinal (16%) cancers. Most (73%) were unknown to palliative care pre-ICU admission; 44% were referred between admission and death. The median time from referral to death was 0 day (range 0-19). On ICU admission, 97-99% warranted referral to palliative care using locally and internationally derived triggers. CONCLUSION All "trigger" tools identified a high proportion of patients who may have warranted a palliative care referral either before or during admission to ICU. The routine use of trigger tools could help streamline referral pathways and underpin the development of an effective consultative model of palliative care within the ICU setting to enhance decision-making about appropriate treatment and patient-centred care.
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Affiliation(s)
- Yashna Nadkarni
- Critical Care Unit, Anaesthetics Department, Royal Marsden NHS Foundation Trust, London, UK.
| | - Ivana Kukec
- University Hospital Centre Zagreb, Zagreb, Croatia
| | - Pascale Gruber
- Critical Care Unit, Anaesthetics Department, Royal Marsden NHS Foundation Trust, London, UK
| | - Shaman Jhanji
- Critical Care Unit, Anaesthetics Department, Royal Marsden NHS Foundation Trust, London, UK
| | - Joanne Droney
- Symptom Control and Palliative Care Team, Royal Marsden NHS Foundation Trust, London, UK
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Corrêa LC, Teles D, Silva OBD, Trindade-Filho GH, Loureiro P, Cavalcati MDSM. Predictors of mortality among patients with acute leukemias admitted to an intensive care unit specialized in patients with hematological disease at a Brazilian hospital. Hematol Transfus Cell Ther 2020; 42:33-39. [PMID: 31103671 PMCID: PMC7031107 DOI: 10.1016/j.htct.2019.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 11/29/2018] [Accepted: 01/07/2019] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Hematologists deal every day with high mortality rates of acute leukemia patients. Many times these patients need Intensive Care Unit (ICU) support and some general ICU teams believe that these patients have a much greater chance of dying than patients with other pathologies. In Brazil, data related to mortality rates and ICUs for acute leukemia patients are scarce. METHODS Therefore, to assess mortality predictors in patients with acute leukemia admitted to a specialized hematological ICU, we evaluated demographics, supportive care, hospitalization time, disease status, admitting diagnosis, neutropenia, number of transfusions and Acute Physiology and Chronic Health Evaluation (APACHE)/Sepsis Related Organ Failure Assessment (SOFA) scores as possible factors associated with mortality. Data were extracted from the first admission records of 110 patients with acute leukemia admitted to the Hemocentro de Pernambuco (Hemope) ICU between 2006 and 2009. RESULTS In this retrospective cohort study, 72/110 of the patients were men, and 64/110 were from the metropolitan area of Recife. The patients' age median was 43.5 years (±17.9); 67.3% had acute myeloid leukemia (AML) and 32.7% had acute lymphoid leukemia. The main admitting diagnosis in the ICU was sepsis (66.7%). The mean APACHE II score was 18.3. Of the total, 65 (59%) died, and the mortality rate was independently related to longer hospitalization (p<0.001), the increase in the APACHE II score (p<0.038) and having received hemodialysis (p<0.006). Neutropenia, receiving multiple transfusions and using any kind of mechanical ventilation or vasoactive drug on admission were not relevant to mortality. Factors associated with higher mortality rates were: longer hospitalization, increase in the APACHE II score, and use of hemodialysis. CONCLUSION With these data, to prevent organ lesions before admission to the ICU, a better strategy might be to reduce mortality for leukemia patients.
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Affiliation(s)
| | - Dahra Teles
- Universidade de Pernambuco (UPE), Recife, PE, Brazil; Fundação de Hematologia e Hemoterapia de Pernambuco (Hemope), Recife, PE, Brazil
| | | | - Gustavo Henriques Trindade-Filho
- Universidade de Pernambuco (UPE), Recife, PE, Brazil; Fundação de Hematologia e Hemoterapia de Pernambuco (Hemope), Recife, PE, Brazil
| | - Paula Loureiro
- Universidade de Pernambuco (UPE), Recife, PE, Brazil; Fundação de Hematologia e Hemoterapia de Pernambuco (Hemope), Recife, PE, Brazil
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Tan AC, Jacques SK, Oatley M, Guminski AD. Characteristics and outcomes of oncology unit patients requiring admission to an Australian intensive care unit. Intern Med J 2019; 49:734-739. [DOI: 10.1111/imj.14160] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 10/30/2018] [Accepted: 10/31/2018] [Indexed: 01/08/2023]
Affiliation(s)
- Aaron C. Tan
- Department of Medical OncologyNorthern Sydney Cancer Centre, Royal North Shore Hospital Sydney New South Wales Australia
| | - Sarah K. Jacques
- Department of Medical OncologyNorthern Sydney Cancer Centre, Royal North Shore Hospital Sydney New South Wales Australia
| | - Meredith Oatley
- Department of Medical OncologyNorthern Sydney Cancer Centre, Royal North Shore Hospital Sydney New South Wales Australia
| | - Alexander D. Guminski
- Department of Medical OncologyNorthern Sydney Cancer Centre, Royal North Shore Hospital Sydney New South Wales Australia
- Melanoma Institute Australia Sydney New South Wales Australia
- Northern Clinical School, University of Sydney Sydney New South Wales Australia
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Ko H, Yan M, Gupta R, Kebbel K, Maiti A, Song J, Nates J, Overman MJ. Predictors of Survival in Patients with Advanced Gastrointestinal Malignancies Admitted to the Intensive Care Unit. Oncologist 2018; 24:483-490. [PMID: 30518614 DOI: 10.1634/theoncologist.2018-0328] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 09/28/2018] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Patients with cancer have a high use of health care utilization at the end of life, which can frequently involve admissions to the intensive care unit (ICU). We sought to evaluate the predictors for outcome in patients with gastrointestinal (GI) cancer admitted to the ICU for nonsurgical conditions. PATIENTS AND METHODS The primary objective was to determine the predictors of hospital mortality. Secondary objectives included investigating the predictors of ICU mortality and hospital overall survival (OS). All patients with GI cancer admitted to the ICU at the University of Texas MD Anderson Cancer Center between November 2012 and February 2015 were retrospectively analyzed. Cancer characteristics, treatment characteristics, and Sequential Organ Failure Assessment (SOFA) scores were analyzed for their effects on survival. RESULTS The characteristics of the 200 patients were as follows: 64.5% male, mean age of 60 years, median SOFA score of 6.7, and tumor types of intestinal (37.5%), hepatobiliary/pancreatic (36%), and gastroesophageal (24%). The hospital mortality was 41%, and overall 6-month mortality was 75%. In multivariate analysis, high admission SOFA score > 5, poor tumor differentiation, and duration of metastatic disease ≤7 months were associated with increased hospital mortality. For OS, high admission SOFA score > 5, poor tumor differentiation, and patients who were not on active chemotherapy because of poor performance had worse outcome. In multivariate analysis, SOFA score remained significant for OS even after excluding patients who died in the ICU. CONCLUSION For patients with metastatic GI cancer admitted to the ICU, SOFA score was predictive for both acute and long-term survival. A patient's chemotherapy treatment status was not predictive for hospital mortality but was for OS. The SOFA score should be utilized in all patients with GI cancer upon ICU admission for prognostication. IMPLICATIONS FOR PRACTICE Patients with cancer have a high use of health care utilization at the end of life, which can frequently involve admissions to the intensive care unit (ICU). Although there have been substantial increases in duration of survival for patients with advanced metastatic cancer, their mortality after an ICU admission remains high. GI malignancy is considered one of the top three lethal cancers estimated in 2017. Survival of critically ill patients with advanced GI cancer should be evaluated to help guide treatment planning.
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Affiliation(s)
- Heidi Ko
- Department of Internal Medicine, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Melissa Yan
- Department of Internal Medicine, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Rohan Gupta
- Department of Hematology and Medical Oncology, Harbor-UCLA Medical Center, Torrance, California, USA
| | - Kayla Kebbel
- Department of Internal Medicine, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Abhishek Maiti
- Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Juhee Song
- Department of Biostatistics, Division of Quantitative Sciences, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Joseph Nates
- Department of Critical Care Medicine, Division of Anesthesiology and Critical Care, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Michael J Overman
- Department of Gastrointestinal Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Leoni D, Encina B, Rello J. Managing the oncologic patient with suspected pneumonia in the intensive care unit. Expert Rev Anti Infect Ther 2017; 14:943-60. [PMID: 27573637 DOI: 10.1080/14787210.2016.1228453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Solid cancer patients are frequently admitted in intensive care units for critical events. Improving survival rates in this setting is considered an achievable goal today. Respiratory failure is the main reason for admission, representing a primary target for research. AREAS COVERED This review presents a diagnostic and therapeutic algorithm for pneumonia and other severe respiratory events in the solid cancer population. It aims to increase awareness of the risk factors and the different etiologies in this changing scenario in which neutropenia no longer seems to be a decisive factor in poor outcome. Bacterial pneumonia is the leading cause, but opportunistic diseases and non-infectious etiologies, especially unexpected adverse effects of radiation, biological drugs and monoclonal antibodies, are becoming increasingly frequent. Options for respiratory support and diagnostics are discussed and indications for antibiotics in the management of pneumonia are detailed. Expert commentary: Prompt initiation of critical care to facilitate optimal decision-making in the management of respiratory failure, early etiological assessment and appropriate antibiotic therapy are cornerstones in management of severe pneumonia in oncologic patients.
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Affiliation(s)
- D Leoni
- a Infectious Disease Department , Tor Vergata University Hospital, University of 'La Sapienza' , Rome , Italy.,b Clinical Research & Innovation in Pneumonia & Sepsis (CRIPS) , Vall d'Hebron Institute of Research , Barcelona , Spain
| | - B Encina
- b Clinical Research & Innovation in Pneumonia & Sepsis (CRIPS) , Vall d'Hebron Institute of Research , Barcelona , Spain
| | - J Rello
- b Clinical Research & Innovation in Pneumonia & Sepsis (CRIPS) , Vall d'Hebron Institute of Research , Barcelona , Spain.,c Centro de Investigación Biomédica En Red - Enfermedades Respiratorias (CIBERES) , Vall d'Hebron Institute of Research , Barcelona , Spain.,d Department of Medicine , Universitat Autònoma de Barcelona , Barcelona , Spain
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Impact of Initial Ventilatory Strategy in Hematological Patients With Acute Respiratory Failure: A Systematic Review and Meta-Analysis. Crit Care Med 2017; 44:1406-13. [PMID: 26909503 DOI: 10.1097/ccm.0000000000001613] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Acute respiratory failure in hematological patients is related to a high mortality. Noninvasive mechanical ventilation may benefit a subset of these patients, but the overall effect on mortality and the risks derived from its failure are unclear. Our objective was to review the impact of initial ventilatory strategy on mortality and the risks related to noninvasive mechanical ventilation failure in this group of patients. DATA SOURCES Data sources, including PubMed and conference proceedings, were searched from the year 2000 to January 2015. STUDY SELECTION We selected studies reporting mortality and the need for mechanical ventilation in hematological patients with acute respiratory failure. DATA EXTRACTION Two trained reviewers independently conducted study selection, abstracted data, and assessed the risk of bias. Discrepancies between reviewers were resolved through discussion and consensus. The outcomes explored were all-cause mortality after mechanical ventilation and incidence of noninvasive mechanical ventilation failure. DATA SYNTHESIS A random-effects model was used in all the analysis. Thirteen studies, involving 2,380 patients, were included. Use of noninvasive mechanical ventilation was related to a better outcome than initial intubation (risk ratio, 0.74; 95% CI, 0.65-0.84). Failure of noninvasive mechanical ventilation did not increase the overall risk of death (risk ratio, 1.02; 95% CI, 0.93-1.13). There were signs of publication bias and substantial heterogeneity among the studies. Compensation of this bias by using the trim-and-fill method showed a significant risk of death after noninvasive mechanical ventilation failure (risk ratio, 1.07; 95% CI, 1.00-1.14). Meta-regression analysis showed that the predicted risk of death for the noninvasive mechanical ventilation group acted as a significant moderator, with a higher risk of death after noninvasive mechanical ventilation failure in those studies reporting lower predicted mortality. CONCLUSIONS Noninvasive mechanical ventilation is associated with a lower risk of death in hematological patients with respiratory failure. Noninvasive mechanical ventilation failure may worsen the prognosis, mainly in less severe patients.
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Miller SJ, Desai N, Pattison N, Droney JM, King A, Farquhar-Smith P, Gruber PC. Quality of transition to end-of-life care for cancer patients in the intensive care unit. Ann Intensive Care 2015. [PMID: 26205668 PMCID: PMC4513017 DOI: 10.1186/s13613-015-0059-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background There have been few studies that have evaluated the quality of end-of-life
care (EOLC) for cancer patients in the ICU. The aim of this study was to explore the quality of transition to EOLC for cancer patients in ICU. Methods The study was undertaken on medical patients admitted to a specialist cancer hospital ICU over 6 months. Quantitative and qualitative methods were used to explore quality of transition to EOLC using documentary evidence. Clinical parameters on ICU admission were reviewed to determine if they could be used to identify patients who were likely to transition to EOLC during their ICU stay. Results Of 85 patients, 44.7% transitioned to EOLC during their ICU stay. Qualitative and quantitative analysis of the patients’ records demonstrated that there was collaborative decision-making between teams, patients and families during transition to EOLC. However, 51.4 and 40.5% of patients were too unwell to discuss transition to EOLC and DNACPR respectively. In the EOLC cohort, 76.3% died in ICU, but preferred place of death known in only 10%. Age, APACHE II score, and organ support, but not cancer diagnosis, were identified as associated with transition to EOLC (p = 0.017, p < 0.0001 and p = 0.001). Conclusions Advanced EOLC planning in patients with progressive disease prior to acute deterioration is warranted to enable patients’ wishes to be fulfilled and ceiling of treatments agreed. Better documentation and development of validated tools to measure the quality EOLC transition on the ICU are needed.
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Affiliation(s)
- Sophie J Miller
- Palliative Care Department, Royal Marsden Hospital, The Royal Marsden NHS Foundation Trust, London, UK,
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Bos MMEM, Verburg IWM, Dumaij I, Stouthard J, Nortier JWR, Richel D, van der Zwan EPA, de Keizer NF, de Jonge E. Intensive care admission of cancer patients: a comparative analysis. Cancer Med 2015; 4:966-76. [PMID: 25891471 PMCID: PMC4529335 DOI: 10.1002/cam4.430] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2014] [Revised: 01/09/2015] [Accepted: 01/12/2015] [Indexed: 12/13/2022] Open
Abstract
The aim of this study was to obtain insight into which proportion of cancer patients is admitted to an Intensive Care Unit (ICU) and how their survival, demographic, and clinical characteristics relate to cancer patients not admitted to the ICU. Data from patients registered with cancer between 2006 and 2011 in four hospitals in the Netherlands were linked to the Dutch National Intensive Care Evaluation registry. About 36,860 patients with cancer were identified, of whom 2,374 (6.4%) were admitted to the ICU. Fifty-six percent of ICU admissions were after surgery, whereas 44% were for medical reasons. The risk for ICU admission was highest among cancer patients treated with surgery either alone or combined with chemotherapy and/or radiation therapy. Only 80 of 1,073 medical ICU admissions (3.3%) were for cancer-specific reasons. Although more women (54.0%) than men were registered with cancer, the proportion of male cancer patients admitted to an ICU was much higher (9.3 vs. 4.0%, P < 0.001). Five-year survival of cancer patients admitted to the ICU was substantial (41%) although median survival was much lower (1,104 days) than in patients not admitted to the ICU (median survival time not reached, P < 0.001). These results show that one out of 16 cancer patients was admitted to an ICU and that ICU support for this group should not be considered futile.
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Affiliation(s)
- Monique M E M Bos
- Department of Medicine, Reinier de Graaf Hospital, Delft, The Netherlands
| | - Ilona W M Verburg
- Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Ineke Dumaij
- Department of Medicine, Reinier de Graaf Hospital, Delft, The Netherlands
| | - Jacqueline Stouthard
- Department of Medical Oncology, Antoni van Leeuwenhoek Hospital, Dutch Cancer Institute, Amsterdam, The Netherlands
| | - Johannes W R Nortier
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Dick Richel
- Department of Medical Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Eric P A van der Zwan
- Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Nicolette F de Keizer
- Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Evert de Jonge
- Department of Intensive Care, Leiden University Medical Center, Leiden, The Netherlands
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Prediction of short- and long-term survival for advanced cancer patients after ICU admission. Support Care Cancer 2014; 23:1647-55. [DOI: 10.1007/s00520-014-2519-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 11/10/2014] [Indexed: 12/12/2022]
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Bos MMEM, Bakhshi-Raiez F, Dekker JWT, de Keizer NF, de Jonge E. Outcomes of intensive care unit admissions after elective cancer surgery. Eur J Surg Oncol 2013; 39:584-92. [PMID: 23490335 DOI: 10.1016/j.ejso.2013.02.014] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Revised: 01/12/2013] [Accepted: 02/06/2013] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Postoperative care for major elective cancer surgery is frequently provided on the Intensive Care Unit (ICU). OBJECTIVE To analyze the characteristics and outcome of patients after ICU admission following elective surgery for different cancer diagnoses. METHODS We analyzed all ICU admissions following elective cancer surgery in the Netherlands collected in the National Intensive Care Evaluation registry between January 2007 and January 2012. RESULTS 28,973 patients (9.0% of all ICU admissions; 40% female) were admitted to the ICU after elective cancer surgery. Of these admissions 77% were planned; in 23% of cases the decision for ICU admission was made during or directly after surgery. The most frequent malignancies were colorectal cancer (25.6%), lung cancer (18.5%) and tumors of the central nervous system (14.3%). Mechanical ventilation was necessary in 24.8% of all patients, most frequently after surgery for esophageal (62.5%) and head and neck cancer (50.2%); 20.7% of patients were treated with vasopressors in the acute postoperative phase, in particular after surgery for esophageal cancer (41.8%). The median length of stay on the ICU was 0.9 days (interquartile ranges [IQR] 0.8-1.5); surgery for esophageal cancer was associated with the longest ICU length of stay (median 2.0 days) with the largest variation (IQR 1.0-4.8 days). ICU mortality was 1.4%; surgery for gastrointestinal cancer was associated with the highest ICU mortality (colorectal cancer 2.2%, pancreatico-cholangiocarcinoma 2.0%). CONCLUSION Elective cancer surgery represents a significant part of all ICU admissions, with a short length of stay and low mortality.
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Affiliation(s)
- M M E M Bos
- Reinier de Graaf Hospital, Department of Internal Medicine, Division of Medical Oncology, Delft, The Netherlands
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Bos MMEM, de Keizer NF, Meynaar IA, Bakhshi-Raiez F, de Jonge E. Outcomes of cancer patients after unplanned admission to general intensive care units. Acta Oncol 2012; 51:897-905. [PMID: 22548367 DOI: 10.3109/0284186x.2012.679311] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Acute admission to an intensive care unit (ICU) of cancer patients is considered with increasing frequency due to a better life expectancy and more aggressive therapies. The aim of this study was to determine the characteristics and outcomes of cancer patients with unplanned admissions to general ICUs, and to compare these with outcomes of critically ill patients without cancer. MATERIAL AND METHODS All unplanned ICU admissions in the Netherlands collected in the National Intensive Care Evaluation registry between January 2007 and January 2011 were analyzed. RESULTS AND CONCLUSION Of the 140,154 patients with unplanned ICU admission 10.9% had a malignancy. Medical cancer patients were more severely ill on ICU admission in comparison with medical non-cancer patients, as reflected by higher needs for mechanical ventilation (50.8% vs. 46.4%, p < 0.001) and vasopressors within 24 hours after admission (41.5% vs. 33.0%, p < 0.001), higher Acute Physiology and Chronic Health Evaluation (APACHE) IV scores (88.1 vs. 67.5, p < 0.001) and a longer ICU stay (5.1 vs. 4.6 days, p < 0.001). In contrast, surgical cancer patients only displayed a modestly higher APACHE IV score on admission when compared with non-cancer surgical patients, whereas the other afore mentioned parameters were lower in the surgical cancer patients group. In-hospital mortality was almost twice as high in medical cancer patients (40.6%) as in medical patients without cancer (23.7%). In-hospital mortality of surgical cancer patients (17.4%) was slightly higher than in patients without cancer (14.6%). These data indicate that unplanned ICU admission is associated with a high mortality in patients with cancer when admitted for medical reasons.
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Affiliation(s)
- Monique M E M Bos
- Reinier de Graaf Hospital, Department of Internal Medicine, Division of Medical Oncology Delft, the Netherlands.
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13
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The Patient with Cancer in Intensive Care. J Intensive Care Soc 2010. [DOI: 10.1177/175114371001100402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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