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Poster display

1799 - Outcomes of critically ill head and neck cancer (HNC) patients (pts) admitted in medical intensive care units (mICU) after oncological treatments

Date

09 Oct 2016

Session

Poster display

Presenters

Ana Catarina Freitas

Citation

Annals of Oncology (2016) 27 (6): 328-350. 10.1093/annonc/mdw376

Authors

A.C.D. Freitas1, M.T. Alexandre1, I. Sargento1, M. Ferreira1, M. Ramos2, A. Marques1, A. Moreira1

Author affiliations

  • 1 Medical Oncology, Instituto Portuguès de Oncologia de Lisboa Francisco Gentil, E.P.E. (IPOLFG EPE), 1099-023 - Lisboa/PT
  • 2 Biostatistics Department, Instituto Portuguès de Oncologia de Lisboa Francisco Gentil, E.P.E. (IPOLFG EPE), 1099-023 - Lisboa/PT
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Abstract 1799

Background

Multimodality treatment improved survival of locally advanced HNC pts. Nevertheless some pts still face poor outcomes due to acute treatment-related toxicities and some will require intensive care during the course of treatment. Literature is limited on this subject.

Methods

We did a retrospective analysis of all consecutive HNC pts critically ill admitted to Oncology Department and transferred to a mICU between Jan 2009-Dec 2014. Main aims: to evaluate clinical and demographic features, treatments, outcomes, and to explore mortality associated factors.

Results

We found 25 HNC pts, 20 (80%) males and 5 (20%) females with a median age of 63 years (range 47-76). Pre-ICU performance status was 0/1 in 24 pts. Twenty one pts (84%) had a Charlson Comorbidity Index (CCI) ≥4. Locoregional advanced disease (stage III/IV) was observed in 24 pts (96%), 21 on tube feeding. The most common primary sites were oral cavity and oropharynx. Prior to ICU, 21(84%) pts were in active treatment: 8 (32%) with neoadjuvant chemotherapy (CT) with TPF (docetaxel, cisplatin, fluorouracil), 11 (44%) with chemoradiation with cisplatin, 1 (4%) with adjuvant CT with PF and 1 (4%) with immunoradiation. Prior to ICU admission 16 pts had grade 3/4 toxicity (renal, hematological, mucosal, hyponatremia, hipoalbuminemia). The main causes for ICU admission were respiratory insufficiency in 14 pts (56%), septic shock in 5 (20%) and both in 5 (20%). Median time to ICU admission was 4 days and the median length of stay was 6 days (range 0-36). At ICU mechanical ventilation was used in 12 pts (48%) and vasoactive support in 11 (44%). Thirteen pts (52%) died during ICU stay and 5 (20%) just after ICU discharge. Seven pts (28%) were discharged, 4 of them continued treatment with reduced intensity. Only 3 pts are long survivals. The overall survival for this group was 7,3 months.

Conclusions

The TPF regimen contributed to a significant number of pts admitted in ICU. A high mortality of HNC pts was observed after an ICU admission, explained by the high comorbidity index and G3/4 treatment related-toxicities. HNC pts often need a careful evaluation to better select those who can tolerate/benefit from aggressive treatment.

Clinical trial identification

Legal entity responsible for the study

Instituto Português de Oncologia de Lisboa Francisco Gentil

Funding

Instituto Português de Oncologia de Lisboa Francisco Gentil

Disclosure

All authors have declared no conflicts of interest.

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