Intensive care unit outcomes among patients with lung cancer in the surveillance, epidemiology, and end results-medicare registry

Abstract

Purpose: Lung cancer is the leading cause of cancer-related mortality. Intensive care unit (ICU) use among patients with cancer is increasing, but data regarding ICU outcomes for patients with lung cancer are limited.

Patients and methods: We used the Surveillance, Epidemiology, and End Results (SEER) -Medicare registry (1992 to 2007) to conduct a retrospective cohort study of patients with lung cancer who were admitted to an ICU for reasons other than surgical resection of their tumor. We used logistic and Cox regression to evaluate associations of patient characteristics and hospital mortality and 6-month mortality, respectively. We calculated adjusted associations for mechanical ventilation receipt with hospital and 6-month mortality.

Results: Of the 49,373 patients with lung cancer admitted to an ICU for reasons other than surgical resection, 76% of patients survived the hospitalization, and 35% of patients were alive 6 months after discharge. Receipt of mechanical ventilation was associated with increased hospital mortality (adjusted odds ratio, 6.95; 95% CI, 6.89 to 7.01; P < .001), and only 15% of these patients were alive 6 months after discharge. Of all ICU patients with lung cancer, the percentage of patients who survived 6 months from discharge was 36% for patients diagnosed in 1992 and 32% for patients diagnosed in 2005, whereas it was 16% and 11% for patients who received mechanical ventilation, respectively.

Conclusion: Most patients with lung cancer enrolled in Medicare who are admitted to an ICU die within 6 months of admission. To improve patient-centered care, these results should guide shared decision making between patients with lung cancer and their clinicians before an ICU admission.

Fig 1.

Survival for patients with lung cancer for the first intensive care unit (ICU) admission for reasons other than postoperative surgical lung cancer resection within 5 years of lung cancer diagnosis by year of diagnosis. (A) Survival to hospital discharge for patients with lung cancer admitted to an ICU. (B) Survival to 6 months after hospital discharge for patients with lung cancer admitted to an ICU. The total cohort was included and categorized by receipt of mechanical ventilation, no receipt of mechanical ventilation and no receipt of care in an intermediate type of ICU, and care in an intermediate type of ICU.