1635 - Intensive care as a key player in the changing paradigm of modern cancer care: a single institution experience

Date 28 September 2012
Event ESMO Congress 2012
Session Publication Only
Topics Supportive Care
Presenter Louise Connell
Authors L.C. Connell1, F. Othman2, B. Marsh2, D.N. Carney1, J.A. McCaffrey1, P. O Gorman3, C.M. Kelly4
  • 1Medical Oncology, Mater Misericordiae University Hospital, 7 - Dublin/IE
  • 2Department Of Intensive Care, Mater Misericordiae University Hospital, 7 - Dublin/IE
  • 3Haematology, Mater Misericordiae University Hospital, 7 - Dublin/IE
  • 4Medical Oncolgy, Mater Misericordiae University Hospital, 7 - Dublin/IE

Abstract

Background

Many metastatic cancers are now treated similar to other chronic diseases. Expanding treatment options, increasing age; co-morbid illness; and improving cancer-specific survival means that decisions regarding the timeliness & appropriateness of transfer to the Intensive Care Unit (ICU) are complex. We sought to examine the clinical, demographic & outcome characteristics of oncology/haematology patients (pts) transferred to ICU at a large academic teaching hospital.

Methods

Data was extracted from a prospectively maintained database for all pts with documented malignancy admitted to ICU between September 2009 & December 2011. Clinicopathological variables examined included; cancer type; tumour stage; time from diagnosis; age; co-morbidities; and treatment history. The Sequential Organ Failure Assessment (SOFA), an ICU-specific scoring system, was reviewed for each patient (pt). We report 30 day & 6-month mortality.

Results

A total of 52 of an eligible 83 pts have been analysed in detail to date. The common cancer types were well represented; breast (11.5%),colorectal(11.5%), lung(11.5%) & acute leukaemia(19.2%). Mean age at time of ICU admission was 60 years (range 29-82). The maximum number of prior lines of chemotherapy (CT) was 5 (range 0-5). Approximately 50% of pts had metastatic disease at time of ICU admission. The most frequent reasons for admission were sepsis (n = 16, 31%) & respiratory distress (n = 15, 29 %). Use of mechanical ventilation, vasopressors & renal dialysis was 51.9%, 61.5% & 21.1% respectively. Four pts (7.7 %) received CT in the ICU setting. ICU-specific mortality was 28.8% (n = 15). Thirty-day and 6-month mortality rates were 38.5% & 61.5% respectively. Data on the remaining 31 pts is currently being analysed and will be available for presentation at the meeting.

Conclusions

A significant proportion of pts admitted to ICU had advanced disease & had received multiple lines of CT previously. The ICU-specific mortality rate was lower than expected at 28.8% and may reflect stringent selection criteria. Pts transferred tended to have had long periods of disease remission/stabilisation or had a new diagnosis of malignancy with unknown CT sensitivity status. Analysis of pt selection at ward level is on-going and will identify other factors influencing ICU transfer decisions.

Disclosure

All authors have declared no conflicts of interest.