David J Shaz1, Stephen M Pastores2, Debra A Goldman3, Natalie Kostelecky2, Richard F Tizon4, Kay See Tan3, Neil A Halpern2. 1. Critical Care Center, Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue C-1179, New York, NY, 10065, USA. shazd@mskcc.org. 2. Critical Care Center, Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue C-1179, New York, NY, 10065, USA. 3. Biostatistics Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA. 4. Department of Pharmacy, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Abstract
PURPOSE: The objective of this study was to evaluate the short- and long-term outcomes of adult patients with solid tumors receiving chemotherapy in the intensive care unit (ICU). METHODS: This was a retrospective single-center study comparing the outcomes of patients with solid tumors who received chemotherapy in the ICU with a matched cohort of ICU patients (by age, sex, and tumor type) who did not receive chemotherapy. Conditional logistic regression and shared frailty Cox regression were used to assess short-term (ICU and hospital) mortality and death by 12-month post-hospital discharge, respectively. RESULTS: Seventy-three patients with solid tumors who received chemotherapy in the ICU were successfully matched. The most common solid tumors included thoracic (30%), genitourinary (26%), and breast (16%). The ICU, hospital, and 12-month (post discharge) mortality rates of patients who recieved chomtherapy in the ICU were 23%, 36%, and 43%, respectively. When compared to the matched cohort of patients who did not receive chemotherapy, patients who received chemotherapy had a significantly longer length of stay in the ICU (median 7 vs. 4 days, p < 0.001) and hospital (median 15 vs. 11 days, p = 0.011) but similar short-term ICU and hospital mortality rates (23% vs. 18% and 36% vs. 38%, respectively). Patients who received chemotherapy in the ICU were at a lower risk of death by 12 months (HR 0.31, p < 0.001) compared to the matched cohort on multivariable analysis. CONCLUSIONS: Patients with solid tumors who received chemotherapy had increased ICU and hospital length of stay compared to patients who did not. Although short-term mortality did not differ, patients who received chemotherapy in the ICU had improved long-term survival. Our data can inform critical care triage decisions to include patients who are to receive chemotherapy in the ICU.
PURPOSE: The objective of this study was to evaluate the short- and long-term outcomes of adult patients with solid tumors receiving chemotherapy in the intensive care unit (ICU). METHODS: This was a retrospective single-center study comparing the outcomes of patients with solid tumors who received chemotherapy in the ICU with a matched cohort of ICU patients (by age, sex, and tumor type) who did not receive chemotherapy. Conditional logistic regression and shared frailty Cox regression were used to assess short-term (ICU and hospital) mortality and death by 12-month post-hospital discharge, respectively. RESULTS: Seventy-three patients with solid tumors who received chemotherapy in the ICU were successfully matched. The most common solid tumors included thoracic (30%), genitourinary (26%), and breast (16%). The ICU, hospital, and 12-month (post discharge) mortality rates of patients who recieved chomtherapy in the ICU were 23%, 36%, and 43%, respectively. When compared to the matched cohort of patients who did not receive chemotherapy, patients who received chemotherapy had a significantly longer length of stay in the ICU (median 7 vs. 4 days, p < 0.001) and hospital (median 15 vs. 11 days, p = 0.011) but similar short-term ICU and hospital mortality rates (23% vs. 18% and 36% vs. 38%, respectively). Patients who received chemotherapy in the ICU were at a lower risk of death by 12 months (HR 0.31, p < 0.001) compared to the matched cohort on multivariable analysis. CONCLUSIONS:Patients with solid tumors who received chemotherapy had increased ICU and hospital length of stay compared to patients who did not. Although short-term mortality did not differ, patients who received chemotherapy in the ICU had improved long-term survival. Our data can inform critical care triage decisions to include patients who are to receive chemotherapy in the ICU.
Entities:
Keywords:
Cancer; Chemotherapy; Intensive care unit; Outcomes; Solid tumors
Authors: Jae-Uk Song; Gee Young Suh; Man Pyo Chung; Hojoong Kim; O Jung Kwon; Chul Won Jung; Won Ki Kang; Keunchil Park; Kyeongman Jeon Journal: Support Care Cancer Date: 2010-03-14 Impact factor: 3.603
Authors: Michael von Bergwelt-Baildon; Michael J Hallek; Alexander A Shimabukuro-Vornhagen; Matthias Kochanek Journal: BMC Cancer Date: 2010-11-08 Impact factor: 4.430
Authors: Alexander Shimabukuro-Vornhagen; Boris Böll; Matthias Kochanek; Éli Azoulay; Michael S von Bergwelt-Baildon Journal: CA Cancer J Clin Date: 2016-06-27 Impact factor: 508.702
Authors: Maria Cristina Franca de Oliveira; Juliana Carvalho Ferreira; Antonio Paulo Nassar Junior; Aldo Lourenço Abbade Dettino; Pedro Caruso Journal: J Intensive Care Med Date: 2017-12-19 Impact factor: 3.510
Authors: Monique M E M Bos; Ilona W M Verburg; Ineke Dumaij; Jacqueline Stouthard; Johannes W R Nortier; Dick Richel; Eric P A van der Zwan; Nicolette F de Keizer; Evert de Jonge Journal: Cancer Med Date: 2015-04-18 Impact factor: 4.452
Authors: Viviane B L Torres; Juliana Vassalo; Ulysses V A Silva; Pedro Caruso; André P Torelly; Eliezer Silva; José M M Teles; Marcos Knibel; Ederlon Rezende; José J S Netto; Claudio Piras; Luciano C P Azevedo; Fernando A Bozza; Nelson Spector; Jorge I F Salluh; Marcio Soares Journal: PLoS One Date: 2016-10-20 Impact factor: 3.240