Characteristics and outcomes of oncology unit patients requiring admission to an Australian intensive care unit

Abstract

Background Patients with advanced malignancies have historically been considered poor candidates for admission to the intensive care unit (ICU); however, prognosis is continually improving, and requirements for ICU access are increasing. Aim To understand the characteristics and outcomes of oncology unit patients admitted to an Australian ICU and identify potential prognostic factors. Methods A single‐centre, retrospective, cohort study conducted at a tertiary public hospital with a quaternary ICU in Sydney, Australia. All patients admitted under the medical oncology team requiring ICU admission between June 2014 and June 2016 were evaluated. Clinical outcomes were determined including mortality, ICU requirements (ventilation, dialysis, vasopressors, infection) and prognostic scores (Acute Physiologic and Chronic Health Evaluation (APACHE) II and Sequential Organ Failure Assessment (SOFA) score). Results There were 96 patients with mean age 61 years, 58% were male and 76% had metastatic disease. Most were receiving palliative treatment (89%), with recent chemotherapy (43%), immunotherapy (10%) and other therapies (5%). Of the 10 patients with recent immunotherapy, three (all with melanoma) required ICU admission due to immunotoxicity; 13% were admitted due to an oncological emergency. Mean APACHE II score was 17 (standard deviation (SD) 5.33), mean SOFA score was 3.99 (SD 2.70), ICU mortality was 5% and hospital mortality was 22%. Using multivariate logistic regression analysis, cancer stage, infection during ICU admission, intracranial mass effect on ICU admission and SOFA score were associated with 30‐day mortality. Conclusion Our patient population had good short‐term survival outcomes despite most receiving palliative treatment. Cancer patients can achieve positive outcomes after ICU admission, and appropriate selection of patients is crucial.

Practical Considerations for Treating Patients With Cancer in the COVID-19 Pandemic

“…Oncologists also need to recognize that patients with metastatic solid organ malignancies have poor survival outcomes after intensive care unit admission, with studies defining predictors as lung cancer (although in the preimmunotherapy era), extent of systemic disease, need for invasive mechanical ventilation, or renal replacement therapy or vasopressor support. [33][34][35][36] The COVID-19 pandemic is unprecedented in our lifetime, and we are likely to have to make difficult and distressing decisions. It is incumbent on us as an oncology community Port flushes can be reduced to every 8-10 weeks in situations of resource limitation.…”

Clinico-demographic and Outcome Predictors in Solid Tumor Patients with Unplanned Intensive Care Unit Admissions: An Observational Study

“… 9 Other single-center studies have reported lower hospital mortalities than in our study (22, 29.8, and 31%, respectively). 10 – 12 The hospital mortality rates vary widely based on inclusion and exclusion criteria, with wide regional differences in epidemiology of cancers and their management. A systematic review published by Puxty et al, which included 31 studies with nearly 75,000 patients, reported an average hospital mortality of 38.2% (33.8–42.7%), with a range of 4.6–76.8%.…”

“…This is in contrast to other studies, which had relatively higher proportion (33–76%) of such patients. 10 , 11 , 17 , 18 To the best of our knowledge, only two studies from Asia 9 , 12 have reported outcomes in this subset of patients. However, these reports did not record whether the presence of distant metastasis was a predictor of mortality or not.…”

Critical care reaching out (further) to help?

“…7 Advanced age 10 does not prevent ICU admission, nor does malignancy. 11,12 Australian and New Zealand ICU practice has made notable contributions both to the development of the concept of a hospital Medical Emergency Team (MET) and Rapid Response Team (RRT) and to the early widespread adoption of this concept, 13 where a team of clinicians, typically ICU-based, provide a safety net for potentially deteriorating patients outside the ICU. The clinical utility of such a hospital rapid response to at-risk patients outside the ICU seemed from the beginning to be self-evident.…”