M Soares1, A-C Toffart2, J-F Timsit3, G Burghi4, C Irrazábal5, N Pattison6, E Tobar7, B F C Almeida8, U V A Silva9, L C P Azevedo10, A Rabbat11, C Lamer12, A Parrot13, V C Souza-Dantas14, F Wallet15, F Blot16, G Bourdin17, C Piras18, J Delemazure19, M Durand20, D Tejera21, J I F Salluh22, E Azoulay23. 1. Post-Graduation Program, Instituto Nacional de Câncer, Rio de Janeiro Department of Clinical Research, D'Or Institute for Research and Education, Rio de Janeiro, Brazil marciosoaresms@gmail.com. 2. Thoracic Oncology Unit. 3. Medical Intensive Care Unit (ICU), Hôpital A. Michallon Chu de Grenoble, Grenoble, France. 4. ICU, Hospital Maciel, Montevideo, Uruguay. 5. ICU, Instituto Medico Especializado Alexander Fleming, Buenos Aires, Argentina. 6. ICU, Royal Brompton NHS Foundation Trust, London ICU, Royal Marsden Hospital, London, UK. 7. ICU, Hospital Clinico Universidad de Chile, Santiago, Chile. 8. ICU, Hospital A. C. Camargo, São Paulo. 9. ICU, Fundação Pio XII-Hospital do Câncer de Barretos, Barretos. 10. ICU, Hospital Sírio Libanês, São Paulo, Brazil. 11. ICU, Hôtel Dieu de Paris, Paris. 12. ICU, Institut Mutualiste Montsouris, Paris. 13. Medical ICU, APHP-Hopital Tenon, Paris, France. 14. ICU, Instituto Nacional de Câncer-Hospital do Câncer I, Rio de Janeiro, Brazil. 15. Medical-Surgical ICU, Hospices Civils de Lyon Centre Hospitalier Lyon Sud, Lyon. 16. ICU, Gustave Roussy, Villejuif. 17. Medical ICU, Hôpital de la Croix-Rousse, Lyon, France. 18. ICU, Vitória Apart Hospital, Vitória, Brazil. 19. Medical ICU, Groupe Hospitalier Pitié Salpêtrière, Paris. 20. Surgical ICU, Hôpital A. Michallon Chu de Grenoble, Grenoble, France. 21. ICU, Hospital de Clínicas, Montevideo, Uruguay. 22. Post-Graduation Program, Instituto Nacional de Câncer, Rio de Janeiro Department of Clinical Research, D'Or Institute for Research and Education, Rio de Janeiro, Brazil. 23. Medical ICU, Saint-Louis Teaching Hospital, Paris, France.
Abstract
BACKGROUND: Detailed information about lung cancer patients requiring admission to intensive care units (ICUs) is mostly restricted to single-center studies. Our aim was to evaluate the clinical characteristics and outcomes of lung cancer patients admitted to ICUs. PATIENTS AND METHODS: Prospective multicenter study in 449 patients with lung cancer (small cell, n = 55; non-small cell, n = 394) admitted to 22 ICUs in six countries in Europe and South America during 2011. Multivariate Cox proportional hazards frailty models were built to identify characteristics associated with 30-day and 6-month mortality. RESULTS: Most of the patients (71%) had newly diagnosed cancer. Cancer-related complications occurred in 56% of patients; the most common was tumoral airway involvement (26%). Ventilatory support was required in 53% of patients. Overall hospital, 30-day, and 6-month mortality rates were 39%, 41%, and 55%, respectively. After adjustment for type of admission and early treatment-limitation decisions, determinants of mortality were organ dysfunction severity, poor performance status (PS), recurrent/progressive cancer, and cancer-related complications. Mortality rates were far lower in the patient subset with nonrecurrent/progressive cancer and a good PS, even those with sepsis, multiple organ dysfunctions, and need for ventilatory support. Mortality was also lower in high-volume centers. Poor PS predicted failure to receive the initially planned cancer treatment after hospital discharge. CONCLUSIONS: ICU admission was associated with meaningful survival in lung cancer patients with good PS and non-recurrent/progressive disease. Conversely, mortality rates were very high in patients not fit for anticancer treatment and poor PS. In this subgroup, palliative care may be the best option.
BACKGROUND: Detailed information about lung cancerpatients requiring admission to intensive care units (ICUs) is mostly restricted to single-center studies. Our aim was to evaluate the clinical characteristics and outcomes of lung cancerpatients admitted to ICUs. PATIENTS AND METHODS: Prospective multicenter study in 449 patients with lung cancer (small cell, n = 55; non-small cell, n = 394) admitted to 22 ICUs in six countries in Europe and South America during 2011. Multivariate Cox proportional hazards frailty models were built to identify characteristics associated with 30-day and 6-month mortality. RESULTS: Most of the patients (71%) had newly diagnosed cancer. Cancer-related complications occurred in 56% of patients; the most common was tumoral airway involvement (26%). Ventilatory support was required in 53% of patients. Overall hospital, 30-day, and 6-month mortality rates were 39%, 41%, and 55%, respectively. After adjustment for type of admission and early treatment-limitation decisions, determinants of mortality were organ dysfunction severity, poor performance status (PS), recurrent/progressive cancer, and cancer-related complications. Mortality rates were far lower in the patient subset with nonrecurrent/progressive cancer and a good PS, even those with sepsis, multiple organ dysfunctions, and need for ventilatory support. Mortality was also lower in high-volume centers. Poor PS predicted failure to receive the initially planned cancer treatment after hospital discharge. CONCLUSIONS: ICU admission was associated with meaningful survival in lung cancerpatients with good PS and non-recurrent/progressive disease. Conversely, mortality rates were very high in patients not fit for anticancer treatment and poor PS. In this subgroup, palliative care may be the best option.
Authors: Fernando G Zampieri; Fernando A Bozza; Giulliana M Moralez; Débora D S Mazza; Alexandre V Scotti; Marcelo S Santino; Rubens A B Ribeiro; Edison M Rodrigues Filho; Maurício M Cabral; Marcelo O Maia; Patrícia S D'Alessandro; Sandro V Oliveira; Márcia A M Menezes; Eliana B Caser; Roberto S Lannes; Meton S Alencar Neto; Maristela M Machado; Marcelo F Sousa; Jorge I F Salluh; Marcio Soares Journal: Intensive Care Med Date: 2016-09-29 Impact factor: 17.440
Authors: Andrew M Romano; Kristine E Gade; Gradon Nielsen; Robert Havard; James H Harrison; Josh Barclay; George J Stukenborg; Paul W Read; Leslie J Blackhall; Patrick M Dillon Journal: Oncologist Date: 2017-02-20