Patterns of ICU admissions and outcomes in patients with solid malignancies over the revolution of cancer treatment

Abstract Background Major therapeutic advances including immunotherapy and targeted therapies have been changing the face of oncology and resulted in improved prognosis as well as in new toxic complications. The aim of this study is to appraise the trends in intensive care unit (ICU) admissions and outcomes of critically ill patients with solid malignancies. We performed a retrospective single-centre study over a 12-year period (2007–2018) including adult patients with solid malignancies requiring unplanned ICU admission. Admission patterns were classified as: (i) specific if directly related to the underlying cancer; (ii) non-specific; (iii) drug-related or procedural adverse events. Results 1525 patients were analysed. Lung and gastro-intestinal tract accounted for the two main tumour sites. The proportion of patients with metastatic diseases increased from 48.6% in 2007–2008 to 60.2% in 2017–2018 (p = 0.004). Critical conditions were increasingly related to drug- or procedure-related adverse events, from 8.8% of ICU admissions in 2007–2008 to 16% in 2017–2018 (p = 0.01). The crude severity of critical illness at ICU admission did not change over time. The ICU survival rate was 77.4%, without any significant changes over the study period. Among the 1279 patients with complete follow-up, the 1-year survival rate was 33.2%. Independent determinants of ICU mortality were metastatic disease, cancer in progression under treatment, admission for specific complications and the extent of organ failures (invasive and non-invasive ventilation, inotropes/vasopressors, renal replacement therapy and SOFA score). One-year mortality in ICU-survivors was independently associated with lung cancer, metastatic disease, cancer in progression under treatment, admission for specific complications and decision to forgo life-sustaining therapies. Conclusion Advances in the management and the prognosis of solid malignancies substantially modified the ICU admission patterns of cancer patients. Despite underlying advanced and often metastatic malignancies, encouraging short-term and long-term outcomes should help changing the dismal perception of critically ill cancer patients.

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Selection criteria for intensive care unit referral of lung cancer patients: a pilot study

European Respiratory Journal ◽

10.1183/09031936.00118114 ◽

2014 ◽

Vol 45 (2) ◽

pp. 491-500 ◽

Cited By ~ 19

Author(s):

Anne-Claire Toffart ◽

Carola Alegria Pizarro ◽

Carole Schwebel ◽

Linda Sakhri ◽

Clemence Minet ◽

...

Keyword(s):

Lung Cancer ◽

Intensive Care Unit ◽

Intensive Care ◽

Cancer Patients ◽

Selection Criteria ◽

Performance Status ◽

Lung Cancer Patients ◽

Icu Admission ◽

Organ Failures ◽

Intensity Of Care

The decision-making process for the intensity of care delivered to patients with lung cancer and organ failure is poorly understood, and does not always involve intensivists. Our objective was to describe the potential suitability for intensive care unit (ICU) referral of lung cancer in-patients with organ failures.We prospectively included consecutive lung cancer patients with failure of at least one organ admitted to the teaching hospital in Grenoble, France, between December 2010 and October 2012.Of 140 patients, 121 (86%) were evaluated by an oncologist and 49 (35%) were referred for ICU admission, with subsequent admission for 36 (73%) out of those 49. Factors independently associated with ICU referral were performance status ⩽2 (OR 10.07, 95% CI 3.85–26.32), nonprogressive malignancy (OR 7.00, 95% CI 2.24–21.80), and no explicit refusal of ICU admission by the patient and/or family (OR 7.95, 95% CI 2.39–26.37). Factors independently associated with ICU admission were the initial ward being other than the lung cancer unit (OR 6.02, 95% CI 1.11–32.80) and an available medical ICU bed (OR 8.19, 95% CI 1.48–45.35).Only one-third of lung cancer patients with organ failures were referred for ICU admission. The decision not to consider ICU admission was often taken by a non-intensivist, with advice from an oncologist rather than an intensivist.

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PCN389 - QUALITY OF LIFE USING EQ-5D-3L MEASURE BEFORE ICU ADMISSION TO PREDICT THE MORTALITY OF CRITICALLY ILL CANCER PATIENTS

Value in Health ◽

10.1016/j.jval.2018.09.2850 ◽

2018 ◽

Vol 21 ◽

pp. S81

Author(s):

A.A. Al Rabayah ◽

S. Salmany ◽

R. Al Froukh ◽

M. AL Rayyan ◽

B. Al Najjar ◽

...

Keyword(s):

Quality Of Life ◽

Cancer Patients ◽

Critically Ill ◽

Icu Admission

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Impact of early ICU admission on outcome of critically ill and critically ill cancer patients: A systematic review and meta-analysis.

Journal of Critical Care ◽

10.1016/j.jcrc.2020.10.008 ◽

2021 ◽

Vol 61 ◽

pp. 82-88

Author(s):

Yannick Hourmant ◽

Arnaud Mailloux ◽

Sandrine Valade ◽

Virginie Lemiale ◽

Elie Azoulay ◽

...

Keyword(s):

Systematic Review ◽

Cancer Patients ◽

Critically Ill ◽

Meta Analysis ◽

Icu Admission

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Priority levels in cancer patients admitted to medical intensive care at a safety net hospital.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e18599 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e18599-e18599

Author(s):

Raisa Epistola ◽

Michael Olufemi Shodiya ◽

Jordan Epistola ◽

Dong Chang ◽

James Jen-Chi Yeh

Keyword(s):

Intensive Care ◽

Cancer Patients ◽

Critically Ill ◽

Statistical Tests ◽

Quality Care ◽

Safety Net ◽

Close Monitoring ◽

Icu Admission ◽

Safety Net Hospital ◽

Priority Levels

e18599 Background: Admissions of cancer patients to intensive care units (ICU) are increasing with improved mortality. While ICU care can be lifesaving, its higher cost does not always result in reduced mortality. Moreover, timely goals of care (GOC) discussions correlate with less ICU use in those with certain cancers. We investigate if hospital mortality and disposition outcomes for cancer patients correlate to triage by ICU providers. Methods: This subgroup analysis of a prospective cohort of 808 patients admitted to the ICU from 1 July 2015- 15 June 2016 at an academic safety net hospital included 106 patients diagnosed with cancer. Medical records were reviewed by ICU physicians, who assigned priority ranks using Society of Critical Care Medicine guidelines: 1: critically ill, needing treatment/monitoring not provided outside of ICU, 2: not critically ill, but requiring close monitoring/potentially immediate intervention, 3: critically ill patients with reduced likelihood of recovery, 4: not appropriate for ICU, equivalent outcomes achieved with non-ICU care. We did a chart review for factors like prior therapy and documentation of GOC discussions. Statistical tests were conducted to examine if priority levels correlate with disposition, mortality, and length of stay (LOS). Results: χ2-tests revealed priority rank correlated with disposition after hospitalization (p<.05) with group 3 having the highest proportion of deaths and lowest proportion of discharges home. It revealed that mortality rate differed by group (p<.05) with logistic regression showing that priority 3 predicted increased mortality (p<.05). ANCOVA indicated ICU LOS differed by priority group (p<.05), with priority 3 averaging the longest LOS. While priority 3 had the most in-hospital GOC discussions, relatively few were documented pre-hospitalization. Conclusions: Overall, our patients were accurately triaged, with worse mortality and discharge outcomes among priority 3 and a dearth of pre-hospitalization GOC documentation for all groups. Our data show the importance of triaging patients and having early, frequent GOC discussions to minimize ICU admission given increasing demand and costs. GOC discussions are associated with less aggressive medical care near death and better patient quality of life. Thus, holding these talks with our sickest patients prior to potential ICU admission is an area to improve cost-effective high quality care.[Table: see text]

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Impact of early ICU admission for critically ill cancer patients: Post-hoc analysis of a prospective multicenter multinational dataset.

Journal of Critical Care ◽

10.1016/j.jcrc.2020.10.022 ◽

2021 ◽

Vol 62 ◽

pp. 6-11

Author(s):

Yannick Hourmant ◽

Achille Kouatchet ◽

René López ◽

Djamel Mokart ◽

Frédéric Pène ◽

...

Keyword(s):

Cancer Patients ◽

Critically Ill ◽

Post Hoc Analysis ◽

Icu Admission ◽

Post Hoc

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Outcome of Critically Ill Patients with Testicular Cancer

BioMed Research International ◽

10.1155/2017/3702605 ◽

2017 ◽

Vol 2017 ◽

pp. 1-7 ◽

Cited By ~ 1

Author(s):

Silvio A. Ñamendys-Silva ◽

Mireya Barragán-Dessavre ◽

Andoreni R. Bautista-Ocampo ◽

Francisco J. García-Guillén ◽

Bertha M. Córdova-Sánchez ◽

...

Keyword(s):

Testicular Cancer ◽

Critically Ill ◽

Critically Ill Patients ◽

Blood Cells ◽

White Blood Cells ◽

Germ Cell Tumors ◽

Mortality Rates ◽

Icu Admission ◽

Organ Failures ◽

Nonseminomatous Germ Cell Tumors

Purpose.To evaluate the clinical characteristics and outcomes of critically ill patients with testicular cancer (TC) admitted to an oncological intensive care unit (ICU).Methods.This was a prospective observational study. There were no interventions.Results.During the study period, 1,402 patients with TC were admitted to the Department of Oncology, and 60 patients (4.3%) were admitted to the ICU. The most common histologic type was nonseminomatous germ cell tumors (55/91.7%). The ICU, hospital, and 6-month mortality rates were 38.3%, 45%, and 63.3%, respectively. The Cox multivariate analysis identified the white blood cells count (HR = 1.06, 95% CI = 1.01–1.11, andP=0.005), ionized calcium (iCa) level (HR = 1.23, 95% CI = 1.01–1.50, andP=0.037), and 2 or more organ failures during the first 24 hours after ICU admission (HR = 3.86, 95% CI = 1.96–7.59, andP<0.001) as independent predictors of death for up to 6 months.Conclusion.The ICU, hospital, and 6-month mortality rates were 38.3%, 45%, and 63.3%, respectively. The factors associated with an increased 6-month mortality rate were white blood cells count, iCa level, and 2 or more organ failures during the first 24 hours after ICU admission.

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Adverse Events of Monoclonal Antibodies Used for Cancer Therapy

BioMed Research International ◽

10.1155/2015/428169 ◽

2015 ◽

Vol 2015 ◽

pp. 1-13 ◽

Cited By ~ 17

Author(s):

Mei Guan ◽

Yan-Ping Zhou ◽

Jin-Lu Sun ◽

Shu-Chang Chen

Keyword(s):

Monoclonal Antibody ◽

Monoclonal Antibodies ◽

Cancer Therapy ◽

Adverse Events ◽

Cancer Patients ◽

Drug Administration ◽

Regulatory Agencies ◽

Solid Malignancies ◽

The Us ◽

Anti Cd20

In 1997, the first monoclonal antibody (MoAb), the chimeric anti-CD20 molecule rituximab, was approved by the US Food and Drug administration for use in cancer patients. Since then, the panel of MoAbs that are approved by international regulatory agencies for the treatment of hematopoietic and solid malignancies has continued to expand, currently encompassing a stunning amount of 20 distinct molecules for 11 targets. We provide a brief scientific background on the use of MoAbs in cancer therapy, review all types of monoclonal antibodies-related adverse events (e.g., allergy, immune-related adverse events, cardiovascular adverse events, and pulmonary adverse events), and discuss the mechanism and treatment of adverse events.

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Prognostic Value of Bone Formation and Resorption Proteins in Heterotopic Ossification in Critically-Ill Patients. A Single-Centre Study

The Journal of Critical Care Medicine ◽

10.2478/jccm-2020-0046 ◽

2021 ◽

Vol 7 (1) ◽

pp. 37-45

Author(s):

Alice Georgia Vassiliou ◽

Edison Jahaj ◽

Zafeiria Mastora ◽

Ioannis Karnezis ◽

Ioanna Dimopoulou ◽

...

Keyword(s):

Bone Formation ◽

Heterotopic Ossification ◽

Critically Ill ◽

Bone Morphogenetic Proteins ◽

Critically Ill Patients ◽

Soft Tissues ◽

Osteoclast Formation ◽

Icu Admission ◽

Icu Discharge ◽

Single Centre Study

Abstract Introduction A potential complication in critically ill patients is the formation of bone in soft tissues, termed heterotopic ossification. The exact pathogenetic mechanisms are still undetermined. Bone morphogenetic proteins induce bone formation, while signalling through the receptor activator of nuclear factor kappa-Β (RANK) and its ligand (RANKL), regulates osteoclast formation, activation, and survival in normal bone modelling and remodelling. Osteoprotegerin protects bone from excessive bone loss by blocking RANKL from binding to RANK. Aim The study aimed to investigate these molecules as potential prognostic biomarkers of heterotopic ossification development in critically ill patients. Materials and Methods In this prospective observational study, BMP-2, RANKL, and osteoprotegerin were measured by ELISA in twenty-eight critically-ill, initially non-septic patients, on admission to an ICU, seven days post-admission, and thirty days after ICU discharge. Results In the critically-ill cohort, nine of the twenty-eight patients developed heterotopic ossification up to the 30-day follow-up time-point. The patients who developed heterotopic ossification exhibited significantly reduced BMP-2 and RANKL levels on ICU admission, compared to patients who did not; Osteoprotegerin readings were similar in both groups. Conclusions Critically-ill patients who will subsequently develop heterotopic ossification, have significantly lower BMP-2 and RANKL levels at the time of ICU admission, suggesting that these proteins may be useful as prognostic markers for this debilitating condition.

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Immune-related adverse events: a retrospective look into the future of oncology in the intensive care unit

Annals of Intensive Care ◽

10.1186/s13613-020-00761-w ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Adrien Joseph ◽

Audrey Simonaggio ◽

Annabelle Stoclin ◽

Antoine Vieillard-Baron ◽

Guillaume Geri ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Adverse Events ◽

Cancer Patients ◽

Immune Checkpoint ◽

Immune Checkpoint Inhibitors ◽

Checkpoint Inhibitors ◽

Primary Tumors ◽

Icu Admission ◽

Paris Area

Abstract Background Immune checkpoint inhibitors have reshaped the standard of care in oncology. However, they have been associated with potentially life-threatening immune-related adverse events. With the growing indications of immune checkpoint inhibitors and their position as a pillar of cancer treatment, intensive care physicians will be increasingly confronted with their side effects. The outcome of patients with severe immune-related adverse events in the intensive care unit remains unknown. This retrospective multicentric study aims to describe the characteristics of patients admitted to the intensive care units of 4 academic hospitals in Paris area while receiving immune checkpoint inhibitor treatment between January 2013 and October 2019. Results Over the study period, 112 cancer patients who received immune checkpoint inhibitors were admitted to the intensive care unit within 60 days after the last dose. ICU admission was related to immune-related adverse events (n = 29, 26%), other intercurrent events (n = 39, 35%), or complications related to tumor progression (n = 44, 39%). Immune-related adverse events were pneumonitis (n = 8), colitis (n = 4), myocarditis (n = 3), metabolic disorders related to diabetes (n = 3), hypophysitis (n = 2), nephritis (n = 2), meningitis or encephalitis (n = 2), hepatitis (n = 2), anaphylaxis (n = 2) and pericarditis (n = 1). Primary tumors were mostly melanomas (n = 14, 48%), non-small-cell lung cancers (n = 7, 24%), and urothelial carcinomas (n = 5, 17%). Diagnosis of melanoma and a neutrophil/lymphocyte ratio < 10 were associated with immune-related diagnosis versus other reasons for ICU admission. During their ICU stay, immune-related adverse events patients needed vasopressors (n = 7), mechanical ventilation (n = 6), and extra-corporeal membrane oxygenation (n = 2). One-year survival was significantly higher for patients admitted for irAE compared to patients admitted for other reasons (p = 0.004). Conclusions Admission to the intensive care unit related to immune-related adverse event was associated with better outcome in cancer patients treated with immune checkpoint inhibitors. Our results support the admission for an intensive care unit trial for patients with suspected immune-related adverse events.

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Outcomes of patients with malignancy admitted to the intensive care units (ICU): A prospective study.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e24001 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e24001-e24001

Author(s):

Hazem Assi ◽

Ibrahim Alameh ◽

Maroun Bou Zerdan ◽

Maya Charafeddine ◽

Jessica Khoury ◽

...

Keyword(s):

Intensive Care ◽

Cancer Patients ◽

Intensive Care Units ◽

Critically Ill ◽

Advanced Cancer ◽

Advanced Cancer Patients ◽

Icu Admission ◽

Icu Discharge ◽

Short And Long Term

e24001 Background: An important aspect of improving outcomes for patients with malignancy is the provision of critical care during periods of acute deterioration. Decisions regarding whether advanced cancer patients should be admitted to the ICU is based on a complex suite of considerations, including short- and long-term prognosis, quality of life, and therapeutic options to treat cancer. We set to describe demographic, clinical, and survival data and to identify factors associated with short- and long-term mortality in critically ill advanced cancer patients with non-elective admissions to general ICUs. Methods: Critically ill adult (≥18-year-old) cancer patients non-electively admitted to the intensive care units at the American University of Beirut Medical Center (AUBMC) between August 1st, 2015, and March 1st, 2019, were included. Demographic, clinical, and laboratory data was prospectively collected from first day of ICU admission up to 30 days after discharge. This study was strictly observational and clinical decisions were left to the discretion of the ICU team and attending physician. Results: Two hundred seventy-two patients were enrolled in the study between August 1st, 2015, and March 31st, 2019, with an ICU mortality rate of 43.4%, with the number rising to 59% within 30 days of ICU discharge. Mean length of stay in our ICU was 14 days with an interquartile range of 1 to 120 days with a median overall survival of 22 days since date of ICU admission. The major reasons for unplanned ICU admission were sepsis/septic shock (54%) and respiratory failure (33.1%). COX regression analysis showed that sepsis, uncontrolled malignancy, ARDS, multi-organ failure, use of vasopressors, use of mechanical ventilation are major predictors of poor prognosis. Direct admission from the ED was associated with a higher risk of mortality (48.9%) than being transferred from the floor (32.6%) (p = 0.014). Additionally, mortality in patients with solid malignancies (47.6%) was higher than those with hematologic malignancies (34.1%) (p = 0.0048). Conclusions: Patients admitted to the ICU in a tertiary care center in the MENA region are at high risk for short term mortality.

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