Analysis of Intent and Reason for Oncologic Therapy Administration in Cancer Patients Admitted to the Intensive Care Unit

2021 ◽  
pp. 088506662110659
Author(s):  
David Shaz ◽  
Stephen M. Pastores ◽  
Lokesh Dayal ◽  
Justin Berkowitz ◽  
Natalie Kostelecky ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Hematologic Malignancies ◽  
Cancer Center ◽  
Curative Intent ◽  
Palliative Intent ◽  
Patients With Cancer ◽  
Continuation Therapy ◽  
Oncologic Therapy ◽  
Tertiary Cancer Center

Purpose To investigate the intent of, and reason for, administration of oncologic therapies in the intensive care unit (ICU). Methods Single center, retrospective, cohort study of patients with cancer who received oncologic therapies at a tertiary cancer center ICU between April 1, 2019 and March 31, 2020. Oncologic therapies included traditional cytotoxic chemotherapy, targeted therapy, immunotherapy, hormonal or biologic therapy directed at a malignancy and were characterized as initiation (initial administration) or continuation (part of an ongoing regimen). Results 84 unique patients (6.8% of total ICU admissions) received oncologic therapies in the ICU; 43 (51%) had hematologic malignancies and 41 (49%) had solid tumors. The intent of oncologic therapy was palliative in 63% and curative in 27%. Twenty-two (26%) patients received initiation and 62 (74%) received continuation oncologic therapies. The intent of oncologic therapy was significantly different by regimen type (initiation vs. continuation, p = <0.0001). Initiation therapy was more commonly prescribed with curative intent and continuation therapy was more commonly administered with palliative intent (p = <0.0001). Oncologic therapies were given in the ICU mainly for an oncologic emergency (56%) and because the patients happened to be in the ICU for a non-oncologic critical illness when their oncologic therapy was due (34.5%). Conclusion Our study provides intensivists with a better understanding of the context and intent of oncologic therapies and why these therapies are administered in the ICU.

Advance care planning and terminal intensive care unit admissions for cancer patients: We can do better.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e23000-e23000
Author(s):  
Joseph Heng ◽  
Ramy Sedhom ◽  
Thomas J. Smith
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
High Risk ◽  
Advance Care Planning ◽  
Hematologic Malignancies ◽  
Cancer Center ◽  
Care Planning ◽  
Code Status ◽  
Risk Of Death ◽  
Advance Care

e23000 Background: Terminal oncology intensive care unit (ICU) admissions are associated with high healthcare costs and decreased quality of life. Chemotherapy can be given in non-curative settings to optimize symptom control, but use of it at the end of life does not improve longevity. In addition, goals of care are too often not addressed for patients at high risk of death. Methods: We carried out a retrospective review identifying patients of a large academic cancer center who were admitted to and expired in an ICU between January 1, 2017 to December 31, 2018. Results: 120 patients met inclusion criteria. Median age was 58 years. Only 15.0% (n = 18) of all patients had advance directives. The majority of patients (94.1%, n = 113) were FULL CODE on admission. Median duration of admission was 10 days. Median time to death from ICU admission was 7.5 days. 65.0% (n = 78) of all patients were intubated, while 15.0% (n = 15) received CPR. 58.3% (n = 70) of the study population had solid malignancies; of note, 97.1% (n = 68) of these patients were metastatic at presentation and had a median ECOG performance status of 2. Patients with metastatic solid tumors typically have a more indolent course of progression compared to patients with hematologic malignancies. However, only 23.5% (n = 16) had discussed goals of care or code status with their outpatient oncologists, despite many seeing them within the last month prior to admission (83.8%, n = 57). Similarly, only 4.0% (n = 2) of patients with hematologic malignancies had advance care planning discussions with their oncologists prior to their terminal ICU admission. 27.5% (n = 33) of all patients had an inpatient palliative care consult. The inpatient pulmonary/critical care team had a high rate of inpatient code status transitions, with 85.6% (n = 97) of FULL CODE admissions transitioning to DNR/DNI. Conclusions: These findings reflect contemporary practice at a major academic cancer center. Despite most patients having regular contact with their outpatient oncologists, the intensity of health care utilization noted highlights a need to optimize recognition of patients at high risk of death and to engage patients in advance care planning discussions to avoid terminal ICU admissions.

scholarly journals Presenting Symptoms in the Emergency Department as Predictors of Intensive Care Unit Admissions and Hospital Mortality in a Comprehensive Cancer Center

2016 ◽  
Vol 12 (5) ◽  
pp. e554-e563 ◽  
Author(s):  
Ahmed F. Elsayem ◽  
Kelly W. Merriman ◽  
Carmen E. Gonzalez ◽  
Sai-Ching J. Yeung ◽  
Patrick S. Chaftari ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Hospital Mortality ◽  
Respiratory Distress ◽  
Altered Mental Status ◽  
Hematologic Malignancies ◽  
Cancer Center ◽  
Hospital Death ◽  
Icu Admission ◽  
Patients With Cancer ◽  
Presenting Symptoms

Purpose: The identification of patients at high risk for poor outcomes may allow for earlier palliative care and prevent futile interventions. We examined the association of presenting symptoms on risk of intensive care unit (ICU) admission and hospital death among patients with cancer admitted through an emergency department (ED). Methods: We queried MD Anderson Cancer Center databases for all patients who visited the ED in 2010. Presenting symptoms, ICU admissions, and hospital deaths were reviewed; patient data analyzed; and risk factors for ICU admission and hospital mortality identified. Results: The main presenting symptoms were pain, fever, and respiratory distress. Of the patients with cancer who visited the ED, 5,362 (58%) were admitted to the hospital at least once (range, 1 to 13 admissions), 697 (13%) were admitted to the ICU at least once, and 587 (11%) died during hospitalization (31% of 233 patients with hematologic malignancies and 27% of 354 patients with solid tumors died in the ICU; P < .001). In multivariable logistic regression, presenting symptoms of respiratory distress or altered mental status; lung cancer, leukemia, or lymphoma; and nonwhite race were independent predictors of hospital death. Patients who died had a longer median length of hospital stay than patients discharged alive (14 v 6 days for hematologic malignancies and 7 v 5 days for solid tumors; P < .001). Conclusion: Patients with cancer admitted through an ED experience high ICU admission and hospital mortality rates. Patients with advanced cancer and respiratory distress or altered mental status may benefit from palliative care that avoids unnecessary interventions.

PREDICTORS OF READMISSION TO THE INTENSIVE CARE UNIT AT A TERTIARY CANCER CENTER

1999 ◽  
Vol 27 (Supplement) ◽  
pp. A47
Author(s):  
Susannah K Kish ◽  
Kristen J Price ◽  
Charles G Martin
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Cancer Center ◽  
Tertiary Cancer Center

scholarly journals Mortality Rate, Demographics, and Clinical Attributes of Patients Dying in the Intensive Care Unit of a Comprehensive Cancer Center in Jordan: A Descriptive Study

2020 ◽  
pp. 003022282092392
Author(s):  
Issa M. Almansour ◽  
Amer A. Hasanien ◽  
Zyad T. Saleh
Keyword(s):  
Intensive Care Unit ◽  
Palliative Care ◽  
Intensive Care ◽  
Mortality Rate ◽  
End Of Life ◽  
End Of Life Care ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Life Care ◽  
Patients With Cancer

Very little is known about the provision of or the need for palliative care in the Middle East, including Jordan. This study investigated the mortality rate, demographics, and clinical attributes of patients with cancer who had died in the intensive care unit (ICU) of a national cancer center over a 3-year period in Jordan. We reviewed the records of 661 patients who had died and found that the majority of the people were terminally ill at the time of admission (had metastatic cancer, multisystem organ dysfunction, and seriously ill). This approach differs from the usual practice worldwide in which it is uncommon to admit patients with cancer to the ICU at the end of life. Improving end-of-life care in the ICUs in Jordan requires further exploration of the cultural context in which end-of-life care practice occurs in Jordan and developing a palliative care approach that fit with the Islamic and Arabic culture.

scholarly journals Outcomes of COVID-19 in Patients With Cancer: A Closer Look at Pre-Emptive Routine Screening Strategies

2021 ◽  
pp. OP.21.00177
Author(s):  
Zhuoer Xie ◽  
Antoine N. Saliba ◽  
Jithma Abeykoon ◽  
Umair Majeed ◽  
Daniel R. Almquist ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Hospital Admission ◽  
Odds Ratio ◽  
Multivariable Analysis ◽  
Absolute Lymphocyte Count ◽  
Routine Screening ◽  
Cancer Center ◽  
Patients With Cancer ◽  
Asymptomatic Patients

PURPOSE: The benefit of routine pre-emptive screening for severe acute respiratory syndrome coronavirus 2 infections in patients with cancer before cancer-directed therapies is unclear. Herein, we characterize the outcomes of a cohort of patients with cancer who were diagnosed with COVID-19 by routine screening (RS) in comparison with those diagnosed on the basis of clinical suspicion or exposure history (nonroutine screening [NRS]). METHODS: A multisite prospective observational study was conducted at three major and five satellite campuses of the Mayo Clinic Cancer Center between March 18 and July 31, 2020. The primary outcome was COVID-19–related hospital admission. Secondary outcomes included intensive care unit admissions and all-cause mortality. RESULTS: Five thousand four hundred fifty-two patients underwent RS in the outpatient setting only, and 44 (0.81%) were diagnosed with COVID-19. RS detected 19 additional patients from the scheduled inpatient admissions for surgical or interventional procedures or inpatient chemotherapy. One hundred sixty-one patients were diagnosed with COVID-19 on the basis of NRS. COVID-19–related hospitalization rate (17.5% v 26.7%; P = .14), intensive care unit admission (1.6% v 5.6%; P = .19), and mortality (4.8% v 3.7%; P = .72) were not significantly different between the RS and NRS groups. In the multivariable analysis, age ≥ 60 years (odds ratio, 4.4; P = .023) and an absolute lymphocyte count ≤ 1.4 × 109/L (odds ratio, 9.2; P = .002) were independent predictors of COVID-19–related hospital admission. CONCLUSION: The COVID-19 positivity rate was low on the basis of RS. Comparing the hospital admission and mortality outcomes with the NRS cohort, there were no significant differences. The value of routine pre-emptive screening of asymptomatic patients with cancer for COVID-19 remains low.

Predictors of and Trends in High-Intensity End-of-Life Care Among Children With Cancer: A Population-Based Study Using Health Services Data

2017 ◽  
Vol 35 (2) ◽  
pp. 236-242 ◽  
Author(s):  
Alisha Kassam ◽  
Rinku Sutradhar ◽  
Kimberley Widger ◽  
Adam Rapoport ◽  
Jason D. Pole ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Health Services ◽  
High Intensity ◽  
Hematologic Malignancies ◽  
Population Based ◽  
Children With Cancer ◽  
Eol Care ◽  
Related Mortality

Purpose Children with cancer often receive high-intensity (HI) medical care at the end-of-life (EOL). Previous studies have been limited to single centers or lacked detailed clinical data. We determined predictors of and trends in HI-EOL care by linking population-based clinical and health-services databases. Methods A retrospective decedent cohort of patients with childhood cancer who died between 2000 and 2012 in Ontario, Canada, was assembled using a provincial cancer registry and linked to population-based health-care data. Based on previous studies, the primary composite measure of HI-EOL care comprised any of the following: intravenous chemotherapy < 14 days from death; more than one emergency department visit; and more than one hospitalization or intensive care unit admission < 30 days from death. Secondary measures included those same individual measures and measures of the most invasive (MI) EOL care (eg, mechanical ventilation < 14 days from death). We determined predictors of outcomes with appropriate regression models. Sensitivity analysis was restricted to cases of cancer-related mortality, excluding treatment-related mortality (TRM) cases. Results The study included 815 patients; of these, 331 (40.6%) experienced HI-EOL care. Those with hematologic malignancies were at highest risk (odds ratio, 2.5; 95% CI, 1.8 to 3.6; P < .001). Patients with hematologic cancers and those who died after 2004 were more likely to experience the MI-EOL care (eg, intensive care unit, mechanical ventilation, odds ratios from 2.0 to 5.1). Excluding cases of TRM did not substantively change the results. Conclusion Ontario children with cancer continue to experience HI-EOL care. Patients with hematologic malignancies are at highest risk even when excluding TRM. Of concern, rates of the MI-EOL care have increased over time despite increased palliative care access. Linking health services and clinical data allows monitoring of population trends in EOL care and identifies high-risk populations for future interventions.

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