Patients with advanced lung cancer harboring oncogenic mutations should be admitted to intensive care units

e18386 Background: Advanced lung cancer (ALC) is a symptomatic disease that is often diagnosed in the context of hospitalization. The index hospitalization may be a window of opportunity to improve cancer care delivery. We aimed to define the frequency of ALC diagnosis associated with hospitalization and the relationship to subsequent cancer care and readmissions. Methods: We identified patients in the SEER-Medicare database with: ALC (stage IIIB-IV non-small cell or small cell), diagnosed 2007 to 2013; with continuous enrollment in Medicare from 6 months prior to lung cancer diagnosis through death or 12/2014; and an index hospitalization within 7 days of their ALC diagnosis. Our primary outcomes of interest were 30-day re-hospitalization and emergency department (ED) use. We examined: utilization of services during index hospitalization, including intensive care and oncology or palliative care consultation; discharge destination; receipt of systemic therapy; and hospice enrollment. Results: Fifty-four percent (n = 28,976) of ALC patients had an index hospitalization, with 90% of those having their cancer diagnosed while hospitalized. During their index hospitalization, 16% had oncology consultation, and 6% had palliative care (PC) consultation. Thirty-three percent were in the intensive care unit. At discharge, 59% returned home, 8% died, and 11% went to hospice. Of those who survived to discharge, 69% later returned to the ED or were re-hospitalized, with 49% of re-hospitalizations and 35% of ED visits occurring within 30 days of the index hospitalization. Thirty-five percent of these patients eventually received systemic treatment for their cancer. By 180 days post-discharge, 77% had enrolled in hospice with a median of 10 days on hospice care. Conclusions: Newly diagnosed ALC patients are high risk for acute care utilization, and many patients experience a return to the hospital early in their cancer trajectory. These patients may benefit from additional health system support prior to hospital discharge to help prevent high-cost, low-value healthcare utilization.

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Admission of Lung Cancer Patients to Intensive Care Units

Acta Médica Portuguesa ◽

10.20344/amp.12312 ◽

2019 ◽

Vol 32 (6) ◽

pp. 473

Author(s):

Luis Carreto ◽

Carla Simão ◽

Miguel Silveira ◽

Maria Amélia Almeida

Keyword(s):

Lung Cancer ◽

Intensive Care ◽

Cancer Patients ◽

Intensive Care Units ◽

Lung Cancer Patients

N/a.

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Intensity of end-of-life health care and mortality after systemic anti-cancer treatment in patients with advanced lung cancer

BMC Cancer ◽

10.1186/s12885-021-07992-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Kersti Oselin ◽

Heti Pisarev ◽

Keit Ilau ◽

Raul-Allan Kiivet

Keyword(s):

Lung Cancer ◽

Health Care ◽

Intensive Care ◽

Cancer Treatment ◽

Significant Proportion ◽

Stage Iv ◽

Advanced Lung Cancer ◽

Insurance Fund ◽

Anti Cancer ◽

Eol Care

Abstract Background We aimed to study the mortality and intensity of health care in patients with advanced lung cancer who received systemic anti-cancer treatment (SACT) compared with patients who were not eligible for SACT (no-SACT). Methods A retrospective cohort of patients with lung cancer, who were treated at the North Estonia Medical Centre from 2015 to 2017, was linked to population-based health care data from the Estonian Health Insurance Fund. We calculated 14- and 30-day mortality after SACT and used a composite measure of intensity of care, comprised from the following: emergency department visit, admission to hospital, admission to intensive care unit, receipt of radiotherapy or systemic treatment. Results The median overall survival (OS) of patients who received at least one cycle of SACT (n = 489) was 9.1 months and in patients with no-SACT (n = 289) 1.3 months (hazard ratio [HR] = 4.23, 95% CI = 3.60–5.00). During the final 30 days of life, intensive EOL care was received by 69.9% of the SACT patients and 43.7% of the no-SACT patients. Intensive EOL care in the last 30 days of life is more probable among patients in the SACT group (odds ratio [OR] = 3.58, 95% CI = 2.54–5.04, p < 0.001), especially in those with a stage IV disease (OR = 1.89, 95% CI = 1.31–2.71, p = 0.001). In the SACT group 6.7 and 14.7% of patients died within 14 days and 30 days after the last cycle, respectively. Conclusions Significant proportion of patients with advanced lung cancer continue to receive intensive care near death. Our results reflect current patterns of EOL care for patients with lung cancer in Estonia. Availability of palliative care and hospice services must be increased to improve resource use and patient-oriented care.

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Clinical outcomes in patients with lung cancer admitted to intensive care units

Annals of Translational Medicine ◽

10.21037/atm-21-298 ◽

2021 ◽

Vol 9 (10) ◽

pp. 836-836

Author(s):

Jinkyeong Park ◽

Woo Jin Kim ◽

Ji Young Hong ◽

Yoonki Hong

Keyword(s):

Lung Cancer ◽

Intensive Care ◽

Clinical Outcomes ◽

Intensive Care Units

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Is Intensive Care Unit Admission an Indicator of Patient-Centered Care for Patients With Advanced Lung Cancer in SEER-Medicare?

Journal of Clinical Oncology ◽

10.1200/jco.2012.44.9488 ◽

2012 ◽

Vol 30 (29) ◽

pp. 3652-3652 ◽

Cited By ~ 2

Author(s):

Shabbir M.H. Alibhai

Keyword(s):

Lung Cancer ◽

Intensive Care Unit ◽

Intensive Care ◽

Intensive Care Unit Admission ◽

Patient Centered Care ◽

Advanced Lung Cancer ◽

Patient Centered ◽

Centered Care

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Intensity of end-of-life health care and mortality after systemic anti-cancer treatment in patients with advanced lung cancer

10.21203/rs.3.rs-19211/v2 ◽

2020 ◽

Author(s):

Kersti Oselin ◽

Heti Pisarev ◽

Keit Ilau ◽

Raul-Allan Kiivet

Keyword(s):

Lung Cancer ◽

Health Care ◽

Intensive Care ◽

Cancer Treatment ◽

Population Based ◽

Infectious Complications ◽

Advanced Lung Cancer ◽

Insurance Fund ◽

Risk Of Death ◽

Anti Cancer

Abstract Background: We aimed to study the mortality and intensity of health care in patients with advanced lung cancer who received systemic anti-cancer treatment (SACT) compared with patients who were not eligible for SACT (no-SACT). Methods: A retrospective cohort of lung cancer patients, who were treated at the North Estonia Medical Centre from 2015–2017, was linked to population-based health care data from the Estonian Health Insurance Fund. We calculated 14- and 30-day mortality after SACT and used a composite measure of intensity of care, comprised from the following: emergency department visit, admission to hospital, admission to intensive care unit, receipt of radiotherapy or systemic treatment. Results: The median overall survival (OS) of patients who received at least one cycle of SACT (n = 489) was 9.1 months and in patients with no-SACT (n = 289) 1.3 months (hazard ratio [HR]=4.23, 95% CI=3.60-5.00). In the SACT group 6.7% and 14.7% of patients died within 14 days and 30 days after the last cycle, respectively. During the final 30 days of life, intensive EOL care was received by 69.9% of the SACT patients and 43.7% of the no-SACT patients (p < 0.001). Among SACT patients, sepsis, bacterial infection and/or neutropenia had a significant adverse effect on survival (HR=1.7, 95% CI=1.3-2.21, p < 0.001), whereas the use of the granulocyte colony stimulating growth factor reduced the risk of death (HR= 0.71, 95% CI=0.54-0.92, p = 0.011). Conclusions: Significant proportions of patients with advanced lung cancer continue to receive intensive care near death. Our results highlight that neutropenia and infectious complications are still the primary cause of early SACT-related death.

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Intensity of end-of-life health care and mortality after systemic anti-cancer treatment in patients with advanced lung cancer

10.21203/rs.3.rs-19211/v3 ◽

2020 ◽

Author(s):

Kersti Oselin ◽

Heti Pisarev ◽

Keit Ilau ◽

Raul-Allan Kiivet

Keyword(s):

Lung Cancer ◽

Health Care ◽

Intensive Care ◽

Cancer Treatment ◽

Population Based ◽

Infectious Complications ◽

Advanced Lung Cancer ◽

Insurance Fund ◽

Risk Of Death ◽

Anti Cancer

Abstract Background: We aimed to study the mortality and intensity of health care in patients with advanced lung cancer who received systemic anti-cancer treatment (SACT) compared with patients who were not eligible for SACT (no-SACT). Methods: A retrospective cohort of patients with lung cancer, who were treated at the North Estonia Medical Centre from 2015–2017, was linked to population-based health care data from the Estonian Health Insurance Fund. We calculated 14- and 30-day mortality after SACT and used a composite measure of intensity of care, comprised from the following: emergency department visit, admission to hospital, admission to intensive care unit, receipt of radiotherapy or systemic treatment. Results: The median overall survival (OS) of patients who received at least one cycle of SACT (n = 489) was 9.1 months and in patients with no-SACT (n = 289) 1.3 months (hazard ratio [HR]=4.23, 95% CI=3.60-5.00). In the SACT group 6.7% and 14.7% of patients died within 14 days and 30 days after the last cycle, respectively. During the final 30 days of life, intensive EOL care was received by 69.9% of the SACT patients and 43.7% of the no-SACT patients (p < 0.001). Among SACT patients, sepsis, bacterial infection and/or neutropenia had a significant adverse effect on survival (HR=1.7, 95% CI=1.3-2.21, p < 0.001), whereas the use of the granulocyte colony stimulating growth factor reduced the risk of death (HR= 0.71, 95% CI=0.54-0.92, p = 0.011). Conclusions: Significant proportions of patients with advanced lung cancer continue to receive intensive care near death. Our results highlight that neutropenia and infectious complications are still the primary cause of early SACT-related death.

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