Outcome of patients admitted to the intensive care unit with newly diagnosed small cell lung cancer

Abstract

Patients with newly diagnosed small cell lung cancer (SCLC) may be considered for admission to an intensive care unit (ICU). Even though SCLC is highly responsive to chemotherapy, it is not clear whether patient outcomes justify the resource use of an ICU. This paper reports the results of a retrospective review of 20 newly diagnosed cases of SCLC who were admitted to one of three ICUs in Melbourne, Australia. Patients who had more than one negative prognostic factor did uniformly poorly, with no survivors beyond 4 months. Five patients were treated with chemotherapy whilst intubated and receiving mechanical ventilatory support. Two of these patients responded to chemotherapy and were extubated 4 days later. Both of these patients were alive and free of tumour recurrence 7 months later. In contrast, patients not treated with chemotherapy died early (within 40 days). We conclude that some patients with SCLC achieve a medium to long-term survival following treatment with chemotherapy instituted during or around the time of their admission to an ICU. The admission to an ICU of selected patients with SCLC may be justified, and prognostic indicators may be of benefit in making these difficult treatment decisions.