Abstract 1829P
Background
Advances in oncology treatment led to longer survival in the metastatic setting. The relevance of transferring these patients into ICU (intensive care units) remains an ethical challenge, due to the burden of care required.
Methods
Cancer patients admitted into ICU from January 2008 to December 2014 were selected from the French nationwide hospital discharge summary database (called PMSI). Metastatic patients were defined as having an ICD10 code (International Classification of Diseases, 10th revision) of metastases (C78*-C79*) in the ICU stay or in the year before. We excluded patients under 18 years old, surgical stays (according to the French diagnoses related groups), and patients with hematological malignancies (C81*-C96*). For each patient, we only studied the first stay with ICU. Our primary endpoint was mortality rate during the ICU inpatient stay.
Results
We included 57,717 patients. The number of included patients gradually increased, from 7144 in 2008 to 9496 in 2014 (+4.7%/year in average). Most patients were men: 34938 (60.5%). Median age was 65.5 years (Q1-Q3: [57.4; 75.4]). The mean total length of stay was 17 days (SD=17.1). Regarding the cancer site, we notably observed 16582 cases of lung cancer (28.7%), 8744 cases of colorectal cancer (15.1%), and 5494 cases of breast cancer (9.1%). Overall, the in-hospital mortality was 32.7%, and was quite stable over time (from 31.6% in 2008 to 33.1% in 2014). The mortality rate varied depending on the cancer site: 18.0% for testicular, 23.0% for others, 23.3% for ovarian, 24.1% for endocrine, 24.9% for colorectal, 30.2% for breast, 30.2% for kidney, 30.6% for skin, 32.8% for female genital, 33.0% for prostatic, 33.3% for multiple, 34.1% for stomach, 37.2% for pancreatic, 37.9% for ear, nose and throat, 38.8% for lung, 40.1% for urinary, 40.5% for hepatobiliary, and 41.2% for esophageal. It increased with age, from 25.6% for 16-49 years old to 35.3% for those over 80.
Conclusions
In metastatic patients admitted in medical ICU, the overall mortality was higher than the general intra-hospital mortality in ICU in France (19%). Although the number of admissions increased, survival rates were quite stable.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.