Studies of survival outcomes in metastatic solid organ cancer patients admitted to the intensive care unit (ICU) are limited, with no documentation of functional status following discharge. Furthermore, despite the poor long term outcome, documentation of advance care planning, including goals-of-care (GOC), is often sub-optimal.
We retrospectively assessed outcomes from patients with incurable metastatic solid organ malignancies non-electively admitted to a tertiary hospital ICU from January 2010 - June 2015. Patient demographics were collected and survival rates analysed and correlated with potential prognostic factors. Post-discharge living arrangements and functional status as assessed by Eastern Cooperative Group performance scores (ECOG) at 1- and 3-months were collected. GOC documentation specifying resuscitation status were collected.
101 patients were treated in the ICU during the study period, with cancer treatment-related complications being the most common reason for admission (47%). The ICU, hospital, 30 day and 12 month mortality rates were 16%, 35%, 41% and 76%, respectively. On multiple-variable analysis, predictors of 30 day mortality were albumin
Survival is poor in patients with metastatic cancer and non-elective ICU admissions, although functional status of surviving patients often recovers by 3 months. Low albumin and ECOG status are simple prognostic markers for mortality in cancer patients. Discussions around advanced care planning need to be made early to avoid inappropriate ICU admissions and interventions given the poor survival rates.
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All authors have declared no conflicts of interest.