4077 - The Reality of Critical Cancer Patients in a Polyvalent Intensive Care Unit

Background

With increased incidence and survival of cancer patients (pts), more oncological candidates are considered for admission in Intensive Care Unit (ICU). Trials demonstrated no significant difference in the outcome of cancer pts compared to non-cancer pts. Our study describes characteristics and outcomes of cancer pts in a polyvalent ICU in Portugal.

Methods

Single-centre retrospective cohort study of consecutive oncological pts admitted to a polyvalent ICU (January 2013 to December 2017). Only pts with active cancer were included. A Cox model was fit with time to death within 6 months as the dependent variable and type of cancer and organ support therapy as the independent ones. Covariate Cox regressions were performed. ROC curve analysis was used to determine the sensitivity of prognostic scores.

Results

Two hundred and thirty-six pts included (1400 ICU admissions), mean age of 53.5 ± 15.3 years and 65% were male. Median length of stay was 3 days (IQR 5). Central nervous system (CNS - 31%), gastrointestinal (18%), genitourinary (17%) and hematological (H - 15%) were the main types of cancer. Curative/diagnostic surgeries (49%) and sepsis (17%) were the main reasons for admission. Vasopressors (VP), invasive mechanical ventilation (IMV) and renal replacement therapy (RRT) >24h were required in 31, 33 and 14% of pts. ICU mortality was 16%, those requiring VP, IMV or RRT were 45, 43 and 67%. Overall survival (OS) was 5.7 months, survival rate at 6 months was 48%. APACHE II and SAPS II scores in H-pts vs solid tumors (ST): 30 vs 20 and 63 vs 38, respectively, p < 0.005; ROC curve analysis with AUC > 0.72. VP, IMV, and RRT were more used in H-pts rather than ST-pts - excluding CNS - (71% vs 35%, p < 0.005; 63% vs 39%, p = 0.013; 29% vs 8%, p = 0.002; 46% vs 13% p < 0.005). Length of stay was longer in H-pts vs ST-pts (12.8 vs 7 days, p = 0.002) as ICU mortality (57% vs 14%, p < 0.005). Median OS in H-pts was 3.1 months and in ST-pts 13.9 months (p < 0.005).

Conclusions

Survival rate at 6 months was better than described in literature. Prolonged ICU stay was associated to worse prognosis, as use of support therapies. A better OS was documented in ST-pts. Both SAPS II and APACHE II scores were reasonably sensible predicting mortality, demonstrating their value in cancer pts.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

Tiago Cruz Tomás.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.