Short- and long-term survival of patients with metastatic solid cancer admitted to the intensive care unit: prognostic factors
Corresponding Author
P. CARUSO phd, icu physician
Hospital A C Camargo – ICU and Respiratory ICU – Pulmonary Division University of Sao Paulo Medical School, São Paulo
Pedro Caruso, ICU Physician, Hospital A C Camargo – ICU and Respiratory ICU – Pulmonary Division University of Sao Paulo Medical School, Rua Professor Antonio Prudente, 211. CEP 01509-010, São Paulo-SP, Brazil (e-mail: [email protected]).Search for more papers by this authorA.C. FERREIRA msc, icu nurse
Hospital A C Camargo – ICU, São Paulo, Brazil
Search for more papers by this authorC.E. LAURIENZO msc, icu respiratory therapist
Hospital A C Camargo – ICU, São Paulo, Brazil
Search for more papers by this authorL.N. TITTON msc, icu respiratory therapist
Hospital A C Camargo – ICU, São Paulo, Brazil
Search for more papers by this authorD.S.M. TERABE msc, icu respiratory therapist
Hospital A C Camargo – ICU, São Paulo, Brazil
Search for more papers by this authorD.S. CARNIELI msc, icu respiratory therapist
Hospital A C Camargo – ICU, São Paulo, Brazil
Search for more papers by this authorD. DEHEINZELIN phd, icu physician
Hospital A C Camargo – ICU, São Paulo, Brazil
Search for more papers by this authorCorresponding Author
P. CARUSO phd, icu physician
Hospital A C Camargo – ICU and Respiratory ICU – Pulmonary Division University of Sao Paulo Medical School, São Paulo
Pedro Caruso, ICU Physician, Hospital A C Camargo – ICU and Respiratory ICU – Pulmonary Division University of Sao Paulo Medical School, Rua Professor Antonio Prudente, 211. CEP 01509-010, São Paulo-SP, Brazil (e-mail: [email protected]).Search for more papers by this authorA.C. FERREIRA msc, icu nurse
Hospital A C Camargo – ICU, São Paulo, Brazil
Search for more papers by this authorC.E. LAURIENZO msc, icu respiratory therapist
Hospital A C Camargo – ICU, São Paulo, Brazil
Search for more papers by this authorL.N. TITTON msc, icu respiratory therapist
Hospital A C Camargo – ICU, São Paulo, Brazil
Search for more papers by this authorD.S.M. TERABE msc, icu respiratory therapist
Hospital A C Camargo – ICU, São Paulo, Brazil
Search for more papers by this authorD.S. CARNIELI msc, icu respiratory therapist
Hospital A C Camargo – ICU, São Paulo, Brazil
Search for more papers by this authorD. DEHEINZELIN phd, icu physician
Hospital A C Camargo – ICU, São Paulo, Brazil
Search for more papers by this authorAbstract
CARUSO P., FERREIRA A.C., LAURIENZO C.E., TITTON L.N., DA SILVA MAIA TERABE D., CARNIELI D.S. & DEHEINZELIN D. (2010) European Journal of Cancer Care19, 260–266Short- and long-term survival of patients with metastatic solid cancer admitted to the intensive care unit: prognostic factors
Decisions for intensive care unit (ICU) admissions in patients with advanced cancer are complex, and the knowledge of survival rates and prognostic factors are essential to these decisions. Ours objectives were to describe the short- and long-term survival of patients with metastatic solid cancer admitted to an ICU due to emergencies and to study the prognostic factors presented at ICU admission that could be associated with hospital mortality. We retrospectively analysed the charts of all patients with metastatic solid cancer admitted over a 1-year period. This gave a study sample of 83 patients. The ICU, hospital, 1-year and 2-year survival rates were 55.4%, 28.9%, 12.0% and 2.4% respectively. Thrombocytopenia (odds ratio 26.2; P = 0.006) and simplified acute physiology score (SAPS II) (odds ratio 1.09; P = 0.026) were independent factors associated with higher hospital mortality. In conclusion, the survival rates of patients with metastatic solid cancer admitted to the ICU due to emergencies were low, but of the same magnitude as other groups of cancer patients admitted to the ICU. The SAPS II score and thrombocytopenia on admission were associated with higher hospital mortality. The characteristics of the metastatic disease, such as number of organs with metastasis and central nervous system metastasis were not associated with the hospital mortality.
REFERENCES
- Aragon-Ching J.B. & Zujewski J.A. (2007) CNS metastasis: an old problem in a new guise. Clinical Cancer Research 13, 1644–1647.
- Azoulay E., Moreau D., Alberti C., Leleu G., Adrie C., Barboteu M., Cottu P., Levy V., Le Gall J.R. & Schlemmer B. (2000) Predictors of short-term mortality in critically ill patients with solid malignancies. Intensive Care Medicine 26, 1817–1823.
- Azoulay E., Alberti C., Bornstain C., Leleu G., Moreau D., Recher C., Chevret S., Le Gall J.R., Brochard L. & Schlemmer B. (2001) Improved survival in cancer patients requiring mechanical ventilatory support: impact of noninvasive mechanical ventilatory support. Critical Care Medicine 29, 519–525.
- Baughman R.P., Lower E.E., Flessa H.C. & Tollerud D.J. (1993) Thrombocytopenia in the intensive care unit. Chest 104, 1243–1247.
- Benoit D.D., Vandewoude K.H., Decruyenaere J.M., Hoste E.A. & Colardyn F.A. (2003) Outcome and early prognostic indicators in patients with a hematologic malignancy admitted to the intensive care unit for a life-threatening complication. Critical Care Medicine 31, 104–112.
- Blot F., Guiguet M., Nitenberg G., Leclercq B., Gachot B. & Escudier B. (1997) Prognostic factors for neutropenic patients in an intensive care unit: respective roles of underlying malignancies and acute organ failures. European Journal of Cancer 33, 1031–1037.
- Boussat S., El'rini T., Dubiez A., Depierre A., Barale F. & Capellier G. (2000) Predictive factors of death in primary lung cancer patients on admission to the intensive care unit. Intensive Care Medicine 26, 1811–1816.
- Charlson M.E., Pompei P., Ales K.L. & Mackenzie C.R. (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. Journal of Chronic Diseases 40, 373–383.
- Cornet A.D., Issa A.I., Van De Loosdrecht A.A., Ossenkoppele G.J., Strack Van Schijndel R.J. & Groeneveld A.B. (2005) Sequential organ failure predicts mortality of patients with a haematological malignancy needing intensive care. European Journal of Haematology 74, 511–516.
- Depuydt P.O., Benoit D.D., Vandewoude K.H., Decruyenaere J.M. & Colardyn F.A. (2004) Outcome in noninvasively and invasively ventilated hematologic patients with acute respiratory failure. Chest 126, 1299–1306.
- Drews R.E. & Weinberger S.E. (2000) Thrombocytopenic disorders in critically ill patients. American Journal of Respiratory and Critical Care Medicine 162, 347–351.
- Earle C.C., Neville B.A., Landrum M.B., Ayanian J.Z., Block S.D. & Weeks J.C. (2004) Trends in the aggressiveness of cancer care near the end of life. Journal of Clinical Oncology 22, 315–321.
-
Headley J.,
Theriault R. &
Smith T.L. (1992) Independent validation of APACHE II severity of illness score for predicting mortality in patients with breast cancer admitted to the intensive care unit.
Cancer
70, 497–503.
10.1002/1097-0142(19920715)70:2<497::AID-CNCR2820700220>3.0.CO;2-H CAS PubMed Web of Science® Google Scholar
- Jennens R.R., Rosenthal M.A., Mitchell P. & Presneill J.J. (2002) Outcome of patients admitted to the intensive care unit with newly diagnosed small cell lung cancer. Lung Cancer 38, 291–296.
- Kress J.P., Christenson J., Pohlman A.S., Linkin D.R. & Hall J.B. (1999) Outcomes of critically ill cancer patients in a university hospital setting. American Journal of Respiratory and Critical Care Medicine 160, 1957–1961.
- Kroschinsky F., Weise M., Illmer T., Haenel M., Bornhaeuser M., Hoeffken G., Ehninger G. & Schuler U. (2002) Outcome and prognostic features of intensive care unit treatment in patients with hematological malignancies. Intensive Care Medicine 28, 1294–1300.
- Le Gall J.R., Lemeshow S. & Saulnier F. (1993) A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. JAMA 270, 2957–2963.
- Maschmeyer G., Bertschat F.L., Moesta K.T., Hausler E., Held T.K., Nolte M., Osterziel K.J., Papstein V., Peters M., Reich G., Schmutzler M., Sezer O., Stula M., Wauer H., Wortz T., Wischnewsky M. & Hohenberger P. (2003) Outcome analysis of 189 consecutive cancer patients referred to the intensive care unit as emergencies during a 2-year period. European Journal of Cancer 39, 783–792.
- Massion P.B., Dive A.M., Doyen C., Bulpa P., Jamart J., Bosly A. & Installe E. (2002) Prognosis of hematologic malignancies does not predict intensive care unit mortality. Critical Care Medicine 30, 2260–2270.
- Miller M.E., Hui S.L. & Tierney W.M. (1991) Validation techniques for logistic regression models. Statistics in Medicine 10, 1213–1226.
- National Cancer Institute (2005) Cancer Trends Progress Report 2005 Update. National Caner Institute, Bethesda, MD, USA.
- Oneschuk D. & Bruera E. (1998) Palliative management of brain metastases. Supportive Care in Cancer 6, 365–372.
- Owczuk R., Wujtewicz M.A., Sawicka W., Wadrzyk A. & Wujtewicz M. (2005) Patients with haematological malignancies requiring invasive mechanical ventilation: differences between survivors and non-survivors in intensive care unit. Supportive Care in Cancer 13, 332–338.
- Silfvast T., Pettila V., Ihalainen A. & Elonen E. (2003) Multiple organ failure and outcome of critically ill patients with haematological malignancy. Acta Anaesthesiologica Scandinavica 47, 301–306.
- Soares M., Salluh J.I., Spector N. & Rocco J.R. (2005) Characteristics and outcomes of cancer patients requiring mechanical ventilatory support for >24 hrs. Critical Care Medicine 33, 520–526.
- Staudinger T., Stoiser B., Mullner M., Locker G.J., Laczika K., Knapp S., Burgmann H., Wilfing A., Kofler J., Thalhammer F. & Frass M. (2000) Outcome and prognostic factors in critically ill cancer patients admitted to the intensive care unit. Critical Care Medicine 28, 1322–1328.
- Strauss R., Wehler M., Mehler K., Kreutzer D., Koebnick C. & Hahn E.G. (2002) Thrombocytopenia in patients in the medical intensive care unit: bleeding prevalence, transfusion requirements, and outcome. Critical Care Medicine 30, 1765–1771.
- Thiery G., Azoulay E., Darmon M., Ciroldi M., De Miranda S., Levy V., Fieux F., Moreau D., Le Gall J.R. & Schlemmer B. (2005) Outcome of cancer patients considered for intensive care unit admission: a hospital-wide prospective study. Journal of Clinical Oncology 23, 4406–4413.
- Vanderschueren S., De Weerdt A., Malbrain M., Vankersschaever D., Frans E., Wilmer A. & Bobbaers H. (2000) Thrombocytopenia and prognosis in intensive care. Critical Care Medicine 28, 1871–1876.
