Patterns of ICU admissions and outcomes in patients with solid malignancies over the revolution of cancer treatment

by Clara Vigneron, Julien Charpentier, Sandrine Valade, Jérôme Alexandre, Samy Chelabi, Lola-Jade Palmieri, Nathalie Franck, Valérie Laurence, Jean-Paul Mira, Matthieu Jamme and Frédéric Pène 

Annals of Intensive Care volume 11, Article number: 182 (2021) Published: 24 December 2021

Background

Major therapeutic advances including immunotherapy and targeted therapies have been changing the face of oncology and resulted in improved prognosis as well as in new toxic complications. The aim of this study is to appraise the trends in intensive care unit (ICU) admissions and outcomes of critically ill patients with solid malignancies. We performed a retrospective single-centre study over a 12-year period (2007–2018) including adult patients with solid malignancies requiring unplanned ICU admission. Admission patterns were classified as: (i) specific if directly related to the underlying cancer; (ii) non-specific; (iii) drug-related or procedural adverse events.

Results

1525 patients were analysed. Lung and gastro-intestinal tract accounted for the two main tumour sites. The proportion of patients with metastatic diseases increased from 48.6% in 2007–2008 to 60.2% in 2017–2018 (p = 0.004). Critical conditions were increasingly related to drug- or procedure-related adverse events, from 8.8% of ICU admissions in 2007–2008 to 16% in 2017–2018 (p = 0.01). The crude severity of critical illness at ICU admission did not change over time. The ICU survival rate was 77.4%, without any significant changes over the study period. Among the 1279 patients with complete follow-up, the 1-year survival rate was 33.2%. Independent determinants of ICU mortality were metastatic disease, cancer in progression under treatment, admission for specific complications and the extent of organ failures (invasive and non-invasive ventilation, inotropes/vasopressors, renal replacement therapy and SOFA score). One-year mortality in ICU-survivors was independently associated with lung cancer, metastatic disease, cancer in progression under treatment, admission for specific complications and decision to forgo life-sustaining therapies.

Conclusion

Advances in the management and the prognosis of solid malignancies substantially modified the ICU admission patterns of cancer patients. Despite underlying advanced and often metastatic malignancies, encouraging short-term and long-term outcomes should help changing the dismal perception of critically ill cancer patients.

 

 

 

 

 

Lactated Ringer’s Versus 4% Albumin on Lactated Ringer’s in Early Sepsis Therapy in Cancer Patients: A Pilot Single-Center Randomized Trial

Lactated Ringer’s Versus 4% Albumin on Lactated Ringer’s in Early Sepsis Therapy in Cancer Patients: A Pilot Single-Center Randomized Trial

by Park, Clarice Hyesuk Lee; de Almeida, Juliano Pinheiro; de Oliveira, Gisele Queiroz; Rizk, Stéphanie Itala; Fukushima, Julia Tizue; Nakamura, Rosana Ely; Mourão, Matheus Moraes; Galas, Filomena Regina Barbosa Gomes; Abdala, Edson; Pinheiro Freire, Maristela; Kalil Filho, Roberto; Costa Auler, Jose Otavio Jr; Nardelli, Pasquale; Martin, Greg S.; Landoni, Giovanni; Hajjar, Ludhmila Abrahao

Critical Care Medicine: October 2019 - Volume 47 - Issue 10 - p e798-e805

Objective: To investigate the effects of the administration of 4% albumin on lactated Ringer’s, when compared with lactated Ringer’s alone, in the early phase of sepsis in cancer patients.

Design: Single-center, randomized, double-blind, controlled-parallel trial.

Setting: A tertiary care university cancer hospital.

Patients: Cancer patients with severe sepsis or septic shock. Interventions: Between October 2014 and December 2016, patients were randomly assigned to receive either bolus of albumin in a lactated Ringer’s solution or lactated Ringer’s solution alone during the first 6 hours of fluid resuscitation after intensive care medicine (ICU) admission. Primary outcome was defined as death from any cause at 7 days. Secondary outcomes were defined as death from any cause within 28 days, change in Sequence Organ Failure Assessment scores from baseline to day 7, days alive and free of mechanical ventilation, days alive and free of vasopressor, renal replacement therapy during ICU stay, and length of ICU and hospital stay.

Measurements and Main Results: A total of 360 patients were enrolled in the trial. At 7 days, 46 of 180 patients (26%) died in the albumin group and 40 of 180 (22%) died in the lactated Ringer’s group (p = 0.5). At 28 days, 96 of 180 patients (53%) died in the albumin group and 83 of 180 (46%) died in the lactated Ringer’s group (p = 0.2). No significant differences in secondary outcomes were observed.

Conclusions: Adding albumin to early standard resuscitation with lactated Ringer’s in cancer patients with sepsis did not improve 7-day survival.

Patients with cancer on the ICU: the times they are changing

Commentary
Patients with cancer on the ICU: the times they are changing
de Jonge E, Bos MM
Critical Care 2009, 13:122 (2 March 2009)
[Abstract] [Full text] [PDF]

Incidence of and risk factors for transferring cancer patients from rehabilitation to acute care units.

Guo Y, Persyn L, Palmer JL, Bruera E.
Related Articles, Compound (MeSH Keyword),
Substance (MeSH Keyword), LinkOut

Am J Phys Med Rehabil. 2008 Aug;87(8):647-53. PMID: 18645323
[PubMed - indexed for MEDLINE]

Black patients with terminal cancer more likely to choose aggressive care at end of life

Black patients with terminal cancer more likely to choose aggressive care at end of life
whites to die in a hospital intensive.....

29 May 2008
CHICAGO—Black patients with advanced cancer were more likely than whites to die in a hospital intensive care unit, reflecting a greater preference among blacks for life-extending treatment even in the face of a terminal prognosis, according to a study led by researchers at Dana-Farber Cancer Institute in Boston. The findings (abstract 6506) will be presented at the annual meeting of the American Society of Clinical Oncology in Chicago on Monday, June 2, 3 - 6 p.m. CT, South Building, Hall100B.
"There is something different about the way black patients and white patients approach the end of life," Trice said, which may be based in cultural attitudes, religious beliefs, and how thoroughly they have been informed about and comprehend their prognosis, among other things.