Chest
Volume 131, Issue 3, March 2007, Pages 840-846
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Original Research: Neoplastic Diseases
Prognosis of Lung Cancer Patients With Life-Threatening Complications

https://doi.org/10.1378/chest.06-2244Get rights and content

Abstract

Background:The management of patients with lung cancer has improved recently, and many of them will require admission to the ICU. The aims of this study were to determine hospital mortality and to identify risk factors for death in a large cohort of critically ill patients.

Methods:Cohort study in two ICUs specialized in the management of patients with cancer, in France and Brazil.

Results:Of the 143 patients (mean age, 61.6 ± 9.9 years [± SD]), 25 patients (17%) had small cell lung cancer and 118 patients (83%) had non-small cell lung cancer. The main reasons for ICU admission were sepsis (44%) and acute respiratory failure (31%). Mechanical ventilation (MV) was used in 100 patients (70%), including 38 patients in whom lung cancer was considered a reason for MV. Hospital mortality was 59% overall and 69% in patients receiving MV. By multivariate logistic regression, airway infiltration or obstruction by cancer, number of organ failures, cancer recurrence or progression, and severity of comorbidities were associated with increased mortality.

Conclusions:The improved survival previously reported in patients with cancer admitted to the ICU seems to extend to patients with lung cancer, including those who need MV. Mortality increased with the number of organ failures, severity of comorbidities, and presence of respiratory failure due to cancer progression. The type of the cancerper sewas not associated with mortality and, therefore, should not be factored into ICU triage decisions.

Section snippets

Design and Setting

This cohort study was performed at the ICUs of the Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil, and of the Hôpital Saint-Louis, Université Paris 7, Assistance Publique, Hôpitaux de Paris, France. The INCA is a 200-bed teaching hospital for patients with cancer. Its ICU is a 10-bed medical-surgical unit. The Hôpital Saint-Louis is a 650-bed hospital with 330 beds in hematology and oncology wards and a 12-bed medical ICU. The organization and admission policies of both ICUs have

Patient Characteristics

The study included 152 patients: 98 patients (64%) from INCA and 54 patients (36%) from Hôpital Saint-Louis. Nine patients from Hôpital Saint-Louis were excluded due to missing data, leaving 143 patients for the study. Baseline patient characteristics were similar in the two institutions (Table 1). The main reasons for ICU admission are depicted inTable 2. Infection was present at ICU admission in 86 patients (60%), with the main categories being community-acquired pneumonia (n = 46, 53%),

Discussion

Many patients with lung cancer require admission to the ICU during the course of the disease. That ICU admission is beneficial in the postoperative period after pulmonary resection for lung cancer is well established. However, when acute life-threatening complications develop, most notably ARF, oncologists and intensivists are often doubtful about the wisdom of ICU admission. ARF in these patients is usually considered a consequence of advanced disease that is not responsive to supportive care.

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    This work was performed at the ICUs of the INCA, Rio de Janeiro, Brazil, and Saint Louis University Hospital-Paris 7 University, Assistance Publique, Hôpitaux de Paris, France.

    Preliminary data were presented as a poster at the Nineteenth Annual Meeting of the European Society of Intensive Care Medicine, Barcelona, Spain, September 24–27, 2006.

    Financial support was provided by institutional funds.

    The authors have no financial or other potential conflicts of interest exist.

    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).

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