Cancer Res Treat.  2019 Jul;51(3):973-981. 10.4143/crt.2018.360.

Improved Survival of Cancer Patients Admitted to the Intensive Care Unit between 2002 and 2011 at a U.S. Teaching Hospital

• Sauer CM
• Dong J
• Celi LA
• Ramazzotti D

• KMID: 2454289
• DOI: http://doi.org/10.4143/crt.2018.360

Abstract

PURPOSE
Cancer patients are at increased risk of treatment- or disease-related admission to the intensive care unit. Over the past decades, both critical care and cancer care have improved substantially. Due to increased cancer-specific survival, we hypothesized that the number of cancer patients admitted to the intensive care unit (ICU) and survival have increased.
MATERIALS AND METHODS
MIMIC-III was used to study trends and outcomes of cancer patients admitted to the ICU between 2002 and 2011. Multiple logistic regression analysis was performed to adjust for confounders of mortality.
RESULTS
Among 41,468 patients analyzed, 1,083 were hemato-oncologic, 4,330 were oncologic and 66 patients had both a hematological and solid malignancy. Admission numbers more than doubled and the proportion of cancer patients in the ICU increased steadily from 2002 to 2011. In both the univariate and multivariate analyses, solid cancers and hematologic cancers were strongly associated with 28-day mortality. This association was even stronger for 1-year mortality, with odds ratios of 4.02 (95% confidence interval [CI], 3.69 to 4.38) and 2.25 (95% CI, 1.93 to 2.62), respectively. Over the 10-year study period, both 28-day and 1-year mortality decreased, with hematologic patients showing the strongest annual adjusted decrease in the odds of death. There was considerable heterogeneity among solid cancer types.
CONCLUSION
Between 2002 and 2011, the number of cancer patients admitted to the ICU more than doubled, while clinical severity scores remained overall unchanged, suggesting improved treatment. Although cancer patients had higher mortality rates, both 28-day and 1-year mortality of hematologic patients decreased faster than that of non-cancer patients, while mortality rates of cancer patients strongly depended on cancer type.

Keyword

Critical care; Intensive care units; Neoplasms; Hematology; Oncology; Trends; Survival

MeSH Terms

Critical Care*
Hematology
Hospitals, Teaching*
Humans
Intensive Care Units*
Logistic Models
Mortality
Multivariate Analysis
Odds Ratio
Population Characteristics

Figure

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  Fig. 1. Changes in overall and cancer-type specific admission to the intensive care unit between 2002 and 2011. Both the proportion and absolute number of cancer patients increased over time. While there are annual fluctuations, proportions by cancer type remain overall similar.

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  Fig. 2. Changes in unadjusted 28-day mortality (A) and unadjusted 1-year mortality (B) over the 10-year period. There are notable differences in mortality between the subgroups, with cancers of the oral cavity/lip/pharynx and other primary origin having the highest mortality rates. Genitourinary (GU) and breast/connective tissue cancers had the lowest mortality rates. Overall, most cancer types show a decrease in mortality rates over time. GI, gastrointestinal cancer; Oral cancer, cancer of the oral cavity/lip/pharynx.

Reference

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