Long-term outcomes and quality of life in critically ill patients with hematological or solid malignancies: a single center study

• Published in: Intensive care medicine Vol. 39; no. 5; pp. 889 - 898
• Main Authors: Oeyen, S. G., Benoit, D. D., Annemans, L., Depuydt, P. O., Van Belle, S. J., Troisi, R. I., Noens, L. A., Pattyn, P., Decruyenaere, J. M.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer-Verlag 01-05-2013; Springer; Springer Nature B.V
• Subjects: Age Factors; Analysis; Anesthesiology; Cancer; Cancer patients; Chi-Square Distribution; Cohort analysis; Comorbidity; Critical care; Critical Care Medicine; Critical Illness; Demography; Emergency Medicine; Female; Health sciences; Hematology; Hospital patients; Hospitals; Humans; Illnesses; Intensive; Intensive care; Intensive Care Units; Male; Medical prognosis; Medicine; Medicine & Public Health; Middle Aged; Morbidity; Mortality; Neoplasms - psychology; Neoplasms - therapy; Oncology, Experimental; Original; Outcome Assessment (Health Care); Pain Medicine; Patient outcomes; Patients; Pediatrics; Pneumology/Respiratory System; Prognosis; Prospective Studies; Quality of Life; Regression Analysis; Remission (Medicine); Severity of Illness Index; Statistics, Nonparametric; Surgery; Surveys and Questionnaires; Triage; Ventilators; Belgium; Long-term outcomes; Solid tumor; Critically ill patient; Hematological malignancy; Quality of life
• ISSN: 0342-4642; 1432-1238
• DOI: 10.1007/s00134-012-2791-x

Purpose
Data concerning long-term outcomes and quality of life (QOL) in critically ill cancer patients are scarce. The aims of this study were to assess long-term outcomes and QOL in critically ill patients with hematological (HM) or solid malignancies (SM) 3 months and 1  year after intensive care unit (ICU) discharge, to compare these with QOL before ICU admission, and to identify prognostic indicators of long-term QOL.
Methods
During a 1 year prospective observational cohort analysis, consecutive patients with HM or SM admitted to the medical or surgical ICU of a university hospital were screened for inclusion. Cancer data, demographics, co-morbidity, severity of illness, organ failures, and outcomes were collected. The QOL before ICU admission, 3 months, and 1 year after ICU discharge was assessed using standardized questionnaires (EuroQoL-5D, Medical Outcomes Study 36-item Short Form Health Survey). Statistical significance was attained at
P
 < 0.05.
Results
There were 483 patients (85 HM, 398 SM) (64 % men) with a median age of 62 years included. Mortality rates of HM compared to SM were, respectively: hospital (34 vs. 13 %), 3 months (42 vs. 17 %), and 1 year (66 vs. 36 %) (
P
 < 0.001). QOL declined at 3 months, but improved at 1 year although it remained under baseline QOL, particularly in HM. Older age (
P
 = 0.007), severe comorbidity (
P
 = 0.035), and HM (
P
 = 0.041) were independently associated with poorer QOL at 1 year.
Conclusions
Long-term outcomes and QOL were poor, particularly in HM. Long-term expectations should play a larger role during multidisciplinary triage decisions upon referral to the ICU.