5643 - Survival Trends in Critically ill Oncology Patients: impact of patient’s eligibility to post-ICU chemotherapy

Background

Survival of patients with solid cancer improved over the last decade. Whether this translates in survival advances when they become critically ill is uncertain. We sought to determine trends in survival over time in critically ill patients with solid tumors.

Methods

Retrospective single center cohort of patients with solid tumors admitted to ICU over a 10-year period. Factors independently associated with day-30 and 1-year mortality after ICU discharge were identified.

Results

A total of 669 patients were admitted. Primary site of cancer was lung (21%), digestive (20%) and breast cancer (19%); 335 patients (54%) had metastasis. A decision to withhold/withdraw life sustaining therapies was implemented in 158 (25%) patients. ICU, Day-30 and one-year mortality were 23%, 35% and 41%. Among the 484 (77%) ICU survivors, 248 (39%) actually underwent an oncologic treatment following ICU discharge. Factors associated with day-30 mortality included: the period of ICU admission (HR = 0.7, p = 0.03 after 2010 vs before 2010), poor performance status (>2) (HR = 1.4, p = 0.03), metastatic stage of cancer (vs localized cancer) (HR = 2.1, p = 0.002), need for mechanical ventilation (HR = 4.5, p < 0.0001, or vasopressors (HR = 2.3, p = 0.0003). Decisions for forgo life-sustaining therapy in ICU were also associated with day-30 mortality (HR = 3.3, p < 0.0001). Factors associated with 1-year mortality included ICU admission after 2010 (HR 0.5, p < 0.001), locally advanced (HR = 1.8, p = 0.002) or metastatic cancer (HR = 2.2, p = 0.002), poor performance status (HR = 1.5, p = 0.01), newly diagnosed cancer at ICU admission (HR = 2.0, p = 0.003) the inability to receive a cancer treatment after ICU discharge (HR = 5.3, p < 0.001) and decisions to forgo life-sustaining therapy throughout ICU stay (HR = 2.3, p < 0.001).

Conclusions

In critically-ill oncology patients, survival improves over time. Tumor staging and performance status impact on both short-term and long-term mortality suggesting that the goals of care should be better fine-tuned in the future. Most importantly, patient’s ability to receive cancer treatment and oncologist willingness to provide optimal cancer management are major determinants of 1-year mortality.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

E. Azoulay.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.