Outcome of invasive mechanical ventilation in cancer patients: Intubate or not to intubate a patient with cancer

Huaringa, Armando J.; Francis, Wassem H.

doi:10.1016/j.jcrc.2018.11.014

Cited by 18 publications

(23 citation statements)

References 35 publications

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“…We found a decrease in hospital mortality over the inclusion period for all three cohorts. These results are in line with several other studies that showed a decreasing trend in hospital mortality of cancer patients (9,(14)(15)(16)(17)(18)(19). Relevant to note is that when cancer patients (either haematological or solid) survived the hospital admission, approximately one third died within the year following the ICU admission.…”

Section: Discussionsupporting

confidence: 91%

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One-Year Mortality of Cancer Patients with an Unplanned ICU Admission: A Cohort Analysis Between 2008 and 2017 in the Netherlands

Zee

Termorshuizen

Benoît

et al. 2020

Preprint

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BackgroundOver the last decades, a decrease in short-term mortality in cancer patients admitted to the ICU has been described in literature. However, it is unclear whether this decrease also results in a decrease in long-term mortality. Therefore, we examined the 1-year mortality of cancer patients (either haematological or solid) with an unplanned ICU admission.Methods and dataAll adult patients registered in the National Intensive Care Evaluation registry with an unplanned ICU admission in the Netherlands between 2008 and 2017 were included. The primary outcome was 1-year mortality, analysed with a mixed-effects cox-proportional hazard regression. We examined the trend in mortality rates over the inclusion period. Furthermore, we compared the 1-year mortality of cancer patients to that of patients without cancer. ResultsWe included 470,305 patients: 10,401 with haematological cancer, 35,920 with solid tumours, and 423,984 without cancer. The 1-year mortality rates were 60.1%, 46.2%, and 28.3% (p<0.01), respectively. While no statistically significant trend was found (p=0.58), a visual inspection of the graph showed a slightly decreasing trend in 1-year mortality over the inclusion period. Although we found a statistical significant difference in 1-year mortality in patients with a solid tumour (p<0.01), visual inspection showed a wide variety per year. We found a decreasing trend in 1-year mortality in ICU patients without a malignancy (p<0.01). Cancer patients surviving their critical illness and hospital admission had a 30% mortality at 1 year. ConclusionThe 1-year mortality in cancer patients with an unplanned ICU admission (either haematological or solid) was significantly higher than that of patients without cancer. A visual inspection showed a slight decrease in 1-year mortality in haematological patients, while the 1-year mortality in patients with a solid tumour varied per year. After hospital discharge, a considerable part of the patients with a malignancy died within 1 year. Physicians should discuss the long-term prognosis after an ICU admission with patients and relatives in order to manage treatments and expectations. Future research should focus on identifying cancer patients who will benefit from an ICU admission.

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Section: Discussionsupporting

confidence: 91%

“…Nowadays, around 10%-30% of the patients admitted to an Intensive Care Unit (ICU) have cancer (12)(13)(14). Several studies show that ICU and hospital mortality of cancer patients has decreased over the years (9,(14)(15)(16)(17)(18)(19).…”

Section: Introductionmentioning

confidence: 99%

One-Year Mortality of Cancer Patients with an Unplanned ICU Admission: A Cohort Analysis Between 2008 and 2017 in the Netherlands

Zee

Termorshuizen

Benoît

et al. 2020

Preprint

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“…In a study in 1993 in the US, cardiac arrest was associated with the worst long-term prognosis, when compared to other causes of ARF with IMV (1-year mortality: 85% vs. 56 ~ 77%) 17 . Other studies also showed that cancer patients with ARF and IMV had very poor prognosis, with a hospital mortality rate of approximately 62–82% and 6-month mortality rate of approximately 77–97% 21 – 23 . Older age is another important factor associated with poor prognosis in our study.…”

Section: Discussionmentioning

confidence: 95%

Prognostic nomogram for elderly patients with acute respiratory failure receiving invasive mechanical ventilation: a nationwide population-based cohort study in Taiwan

Hsu

Hung

Chu

et al. 2020

Sci Rep

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Patients in critical care medicine are ageing. There is limited literature evaluating long-term outcomes and prognostic factors for the growing number of elderly patients with acute respiratory failure (ARF) receiving invasive mechanical ventilation (IMV). Data on elderly patients (≧ 65 years old) with ARF receiving intubation and IMV during 2003–2012 were retrospectively collected from the national health database in Taiwan. We included 7,095 elderly patients. The 28-day mortality was 33%, the 60-day mortality was 47.5%, and the 1-year mortality was 70.4%. Patients were divided into groups: young-old (65–74 years), middle-old (75–84 years), and oldest-old (≧ 85 years). Patients in the oldest-old and middle-old groups had higher 1-year mortality than the young-old group ( p < 0.001). The multivariate logistic regression revealed 9 significant factors associated with 1-year mortality, and these factors were used to develop a prognostic nomogram. The present study showed that the long-term prognosis of elderly patients with ARF and IMV is very poor. This nomogram can help physicians estimate the 1-year mortality of elderly patients in the early stage of ARF and assist in clinical decision making.

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“…Over the years, there has been an improvement in the outcome of cancer patients admitted to the ICU, with an average survival of 32.4% and a long-term survival of 10.2%. [4] Among the risk factors for short-term mortality: age, severity and number of failing organs, presence of acute respiratory failure, PS, comorbidities and stage of the disease play a fundamental role. [3,4] Moreover, the Sequential Organ Failure Assessment (SOFA) score was reported as one of the major predictors of outcome for cancer patients admitted to ICU.…”

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confidence: 99%

The Appropriateness of Invasive Ventilation in COVID-19 Positive Cancer Patients: The Hardest Decision for Oncologists

Ghidini¹,

Indini²,

Rijavec³

et al. 2020

Preprint

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Over the last two months, as oncology specialists, we have frequently been contacted for estimating prognosis for cancer patients affected by COVID-19 infection. Until now, there have been no clear markers to guide decision making regarding the appropriateness of invasive ventilation in cancer patients affected by COVID-19 infection. Therefore, we developed a practical tool encompassing a prognostic score. We aimed at identifying a subgroup of patients likely to have a better outcome and therefore may be potential candidates for invasive ventilation, "The Milano Policlinico ONCOVID-ICU score". The score is composed by three groups of variables: patient’s characteristics such as sex, age, BMI and comorbidities; oncological variables (treatment intent, life expectancy, on or off-treatment status) and clinical parameters in association with laboratory values (SOFA score and D-dimer). The SOFA score includes six different clinical parameters and during the first few days of ICU admissions has an important prognostic role. The oncological history should never represent, per se, a contraindication to intensive care and must be considered together with other variables, such as laboratory values, clinical parameters and patient characteristics, in order to make the hardest but best possible choice. The Milano Policlinico ONCOVID-ICU score, to our knowledge, is the first prognostic score proposed in this setting of patients and may be a useful tool to assess the prognosis of cancer patients being in this critical condition.

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Outcome of invasive mechanical ventilation in cancer patients: Intubate or not to intubate a patient with cancer

Cited by 18 publications

References 35 publications

One-Year Mortality of Cancer Patients with an Unplanned ICU Admission: A Cohort Analysis Between 2008 and 2017 in the Netherlands

One-Year Mortality of Cancer Patients with an Unplanned ICU Admission: A Cohort Analysis Between 2008 and 2017 in the Netherlands

Prognostic nomogram for elderly patients with acute respiratory failure receiving invasive mechanical ventilation: a nationwide population-based cohort study in Taiwan

The Appropriateness of Invasive Ventilation in COVID-19 Positive Cancer Patients: The Hardest Decision for Oncologists

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