Intensive care in patients with lung cancer : a multinational study
Soares, M; Toffart, A-C; Timsit, J-F; Burghi, G; Irrazábal, C; Pattison, N; Tobar, E; Almeida, B F C; Silva, U V A; Azevedo, L C P; Rabbat, A; Lamer, C; Parrot, A; Souza-Dantas, V C; Wallet, F; Blot, F; Bourdin, G; Piras, C; Delemazure, J; Durand, M; Tejera, D; Salluh, J I F; Azoulay, E; Lung Cancer in Critical Care (LUCCA) Study Investigators
Citation: Soares , M , Toffart , A-C , Timsit , J-F , Burghi , G , Irrazábal , C , Pattison , N , Tobar , E , Almeida , B F C , Silva , U V A , Azevedo , L C P , Rabbat , A , Lamer , C , Parrot , A , Souza-Dantas , V C , Wallet , F , Blot , F , Bourdin , G , Piras , C , Delemazure , J , Durand , M , Tejera , D , Salluh , J I F , Azoulay , E & Lung Cancer in Critical Care (LUCCA) Study Investigators 2014 , ' Intensive care in patients with lung cancer : a multinational study ' Annals of Oncology , vol 25 , no. 9 , pp. 1829-35 . DOI: 10.1093/annonc/mdu234
BACKGROUND: Detailed information about lung cancer patients requiring admission to intensive care units (ICUs) is mostly restricted to single-center studies. Our aim was to evaluate the clinical characteristics and outcomes of lung cancer patients admitted to ICUs. PATIENTS AND METHODS: Prospective multicenter study in 449 patients with lung cancer (small cell, n = 55; non-small cell, n = 394) admitted to 22 ICUs in six countries in Europe and South America during 2011. Multivariate Cox proportional hazards frailty models were built to identify characteristics associated with 30-day and 6-month mortality. RESULTS: Most of the patients (71%) had newly diagnosed cancer. Cancer-related complications occurred in 56% of patients; the most common was tumoral airway involvement (26%). Ventilatory support was required in 53% of patients. Overall hospital, 30-day, and 6-month mortality rates were 39%, 41%, and 55%, respectively. After adjustment for type of admission and early treatment-limitation decisions, determinants of mortality were organ dysfunction severity, poor performance status (PS), recurrent/progressive cancer, and cancer-related complications. Mortality rates were far lower in the patient subset with nonrecurrent/progressive cancer and a good PS, even those with sepsis, multiple organ dysfunctions, and need for ventilatory support. Mortality was also lower in high-volume centers. Poor PS predicted failure to receive the initially planned cancer treatment after hospital discharge. CONCLUSIONS: ICU admission was associated with meaningful survival in lung cancer patients with good PS and non-recurrent/progressive disease. Conversely, mortality rates were very high in patients not fit for anticancer treatment and poor PS. In this subgroup, palliative care may be the best option.
This is a pre-copyedited, author-produced version of an article accepted for publication in Annals of Oncology following peer review. The version of record M. Soares, et al, 'Intensive care in patients with lung cancer: a multinational study', Annals of Oncology, Vol. 25 (9): 1829-1835, September 2014, is available online at https://doi.org/10.1093/annonc/mdu234.
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