Introduction Given clinicians’ frequent concerns about unfavourable outcomes, Intensive Care Unit (ICU) triage decisions in acutely ill cancer patients can be difficult, as clinicians may have doubts about the appropriateness of an ICU admission. To aid to this decision making, we studied the survival and performance status of cancer patients 2 years following an unplanned ICU admission. Materials and methods This was a retrospective cohort study in a large tertiary referral university hospital in the Netherlands. We categorized all adult patients with an unplanned ICU admission in 2017 into two groups: patients with or without an active malignancy. Descriptive statistics, Pearson’s Chi-square tests and the Mann-Whitney U tests were used to evaluate the primary objective 2-year mortality and performance status. A good performance status was defined as ECOG performance status 0 (fully active) or 1 (restricted in physically strenuous activity but ambulatory and able to carry out light work). A multivariable binary logistic regression analysis was used to identify factors associated with 2-year mortality within cancer patients. Results Of the 1046 unplanned ICU admissions, 125 (12%) patients had cancer. The 2-year mortality in patients with cancer was significantly higher than in patients without cancer (72% and 42.5%, P <0.001). The median performance status at 2 years in cancer patients was 1 (IQR 0–2). Only an ECOG performance status of 2 (OR 8.94; 95% CI 1.21–65.89) was independently associated with 2-year mortality. Conclusions In our study, the majority of the survivors have a good performance status 2 years after ICU admission. However, at that point, three-quarter of these cancer patients had died, and mortality in cancer patients was significantly higher than in patients without cancer. ICU admission decisions in acutely ill cancer patients should be based on performance status, severity of illness and long-term prognosis, and this should be communicated in the shared decision making. An ICU admission decision should not solely be based on the presence of a malignancy.

Background Intensive Care Unit (ICU) triage decisions in patients with a malignancy can be difficult as clinicians have concerns about potential unfavourable outcomes. Therefore, clinicians may have doubts about the appropriateness of an ICU admission. The aim of this study was to assess the long-term mortality and performance status of critically ill patients with an active malignancy or a malignancy in their prior history admitted unplanned to the ICU. Furthermore, we aimed to compare the long-term mortality of those patients to the mortality of patients without a malignancy. Methods We conducted a retrospective cohort study in a large tertiary referral university hospital in the Netherlands. We categorized all adult patients with an unplanned admission to the ICU in 2017 in two groups: 1) the study population consisting of patients with an active malignancy and patients with a malignancy in their medical history (complete remission, CR) and 2) patients without a malignancy. Pearson’s Chi-square tests and Independent Samples T-Tests or the Mann-Whitney U tests were used to evaluate the long-term mortality, the primary objective was 2-year mortality. Results Of the 1046 unplanned ICU admissions, 125 (12%) patients had an active malignancy, 41 (3.9%) < 5 year CR and 33 (3.2%) ≥ 5 year CR. The 2-year mortality in the study population was significantly higher than in the population without a malignancy (67.4% and 40.2%, P < 0.001). The median performance status at 2 years after ICU admission in the study population was 1 (IQR 0–2). SOFA score (OR 1.25; 95% CI 1.10–1.42) and ECOG performance status of 2 (OR 11.23; 95% CI 2.66–47.33), 3 (OR 5.91; 95% CI 1.77–19.79) and 4 (OR 13.16; 1.85–93.74) were independently associated with 2-year mortality. Conclusions Two thirds of the study population died within 2 years after ICU admission, which is higher than in the population without a malignancy. However, the majority of the study population had a good performance status at 2 years after ICU admission. The severity of the critical illness and the performance status before ICU admission are independently associated with 2-year mortality and should be considered as main factors in ICU triage.