Survival trends in critically ill oncology patients: Impact of patient’s eligibility to post-ICU chemotherapy

Abstract

Abstract 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\xa0=\xa00.7, p\xa0=\xa00.03 after 2010 vs before 2010), poor performance status (>2) (HR\xa0=\xa01.4, p\xa0=\xa00.03), metastatic stage of cancer (vs localized cancer) (HR\xa0=\xa02.1, p\xa0=\xa00.002), need for mechanical ventilation (HR\xa0=\xa04.5, p\xa0 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. Legal entity responsible for the study E. Azoulay. Funding Has not received any funding. Disclosure All authors have declared no conflicts of interest.