Intensive care in patients with lung cancer: a multinational study

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. Prospective multicenter study in 449 patients...

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Published in:	Annals of oncology Vol. 25; no. 9; pp. 1829 - 1835
Main Authors:	Soares, M., Toffart, A.-C., Timsit, J.-F., Burghi, G., Irrazábal, C., Pattison, N., Tobar, E., Almeida, B.F.C., Silva, U.V.A., Azevedo, L.C.P., Rabbat, A., Lamer, C., Parrot, A., Souza-Dantas, V.C., Wallet, F., Blot, F., Bourdin, G., Piras, C., Delemazure, J., Durand, M., Tejera, D., Salluh, J.I.F., Azoulay, E.
Format:	Journal Article
Language:	English
Published:	Oxford Elsevier Ltd 01-09-2014 Oxford University Press
Subjects:	Antineoplastic agents Biological and medical sciences cancer-related complications Carcinoma, Non-Small-Cell Lung - mortality Carcinoma, Non-Small-Cell Lung - therapy Cohort Studies Critical Care Female Humans intensive care Lung - pathology lung cancer Lung Neoplasms - mortality Lung Neoplasms - therapy Male Medical sciences Middle Aged multicenter study Multiple tumors. Solid tumors. Tumors in childhood (general aspects) outcome Pharmacology. Drug treatments Pneumology Prospective Studies Severity of Illness Index Treatment Outcome Tumors Tumors of the respiratory system and mediastinum lung cancer multicenter study intensive care cancer-related complications outcome Human Lung disease Intensive care Prognosis Respiratory disease Lung cancer Multicenter study Malignant tumor Bronchopulmonary Bronchus disease Complication Cancer
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Summary:	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. 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. 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. 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.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 ObjectType-Undefined-3
ISSN:	0923-7534 1569-8041
DOI:	10.1093/annonc/mdu234