2142P - Criteria for the choice of therapeutic ceiling in the hospitalized oncology patient: Healthcare impact of the multidisciplinary committee with the Intensive Care Unit (ICU)

Background

The improvement in cancer survival, allows for higher ICU admission ratios. A pilot program in our center instituted weekly meetings between ICU and Oncology aimed at determining the appropriate level of care for patients admitted in Oncology. Objective: establish which factors predict decision-making regarding the level of care and admission to the ICU and benefit of intensive care.

Methods

Single-center prospective observational study. Recruitment between September-2021 and July-2022. Statistical analysis: descriptive study, multivariate logistic regression for decision of admission in ICU. We performed a second subsequent analysis with the paired propensity score matching technique. Survival analysis: Kaplan-Meier (KM) curves and log-Rank test. Significance level: p ≤ 0.05.

Results

411 patients. 60.3% male; median age: 64 years. Most prevalent tumor: lung (26.3%). Stage IV: 72.5%. The most common reason for admission in Oncology: infectious pathology (33.8%). 54.7% were considered ICU candidates, while only 17 patients (4.1%) finally required intensive care. In a multivariate logistic regression model, ECOG 0-1 (OR 2.7; IC95%: 1.6-4.5), absence of peritoneal carcinomatosis (OR 4.5; IC95%: 2.0-9.9), and intentionality of treatment (adjuvant, neoadjuvant or first-line) (OR 5.4; IC 95%: 3.1-9.5) predicted decision of admission to the ICU. Age > 65 years (OR 0.35; IC 95%: 0.2-0.6) and poor symptom control as cause of admission in Oncology (OR 0.16; 95%: 0.03-0.93) were negative factors for ICU admission. By means of paired propensity analysis (Nearest-neighbor model), the sample was reduced to 172 patients and there was only statistical significance in the univariate analysis for intentionality of treatment and for treatment with immunotherapy (IT). After a median follow-up of 4 months, median survival was significantly different (p< 0.05) for patients who were not ICU candidates (2.5 months), patients who were admitted to the ICU (10 months) and patients who were ICU candidates but did not require admission (12.5 months).

Conclusions

Multidisciplinary decision-making may contribute to individualize the level of intensive care for Oncology patients.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

F. Ayala de la Pena

Funding

Has not received any funding.

Disclosure

M. Sanchez Canovas: Financial Interests, Advisory Board: Leo Pharma, Sanofi, Lundbeck, Angelini. All other authors have declared no conflicts of interest.