Intensive care units can provide meaningful survival for patients with lung cancer who have good performance status and nonrecurrent disease, even if they have severe complications such as sepsis or multiple organ failure, authors of a multicenter observational cohort study reported online in Annals of Oncology.
Mortality rates, however, were "very high" in ICU patients with poor performance status who were deemed unfit for lung cancer treatment, indicating that palliative care may be their best option, said Dr. Marcio Soares of the Instituto Nacional de Câncer and the D’Or Institute for Research and Education, Rio de Janeiro, and his associates.
Patients with lung cancer often are seen as having poor ICU outcomes, even though survival data and multicenter studies for these patients are lacking, the investigators said. They carried out a prospective, multicenter observational cohort study of 449 adults with lung cancer who were admitted to 22 intensive care units in six European and South American countries. A total of 394 (88%) patients had non–small cell lung cancer and the rest had small cell disease (Ann. Oncol. 2014 June 20 [doi:10.1093/annonc/mdu234]).
In all, 28% of patients died in the ICU: 41% of those died within 30 days of admission and 55% died within 6 months – rates that resemble those for unselected ICU cancer patients from prior multicenter studies. Most 6-month survivors were living at home. After the researchers controlled for medical versus surgical ICU admission and early decisions to limit treatment, predictors of 30-day and 6-month mortality included poor performance status; presence of recurrent or progressive disease; cancer complications such as airway compromise, deep vein thrombosis, and superior vena cava syndrome; and severity of acute organ dysfunction, Dr. Soares and his associates reported.
"Importantly, admission to high-volume centers was associated with lower mortality. This effect may be related to expertise, closer collaboration between oncologists and intensivists, or more efficient ICU triage policies," the investigators added.
The study was based on a convenience sample of ICUs, and the researchers said that they did not collect data on quality of life or follow patients beyond 6 months after ICU admission.
The authors reported no conflicts of interest. The study was supported by the National Council for Scientific and Technological Development and Fundação Carlos Chagas Filho de Amparo à Pesquisa do Estado do Rio de Janeiro, and by departmental funds from the D’Or Institute for Research and Education and Instituto Nacional de Câncer in Brazil.