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. 2015 Jul;4(7):966-76.
doi: 10.1002/cam4.430. Epub 2015 Apr 18.

Intensive care admission of cancer patients: a comparative analysis

Monique M E M Bos  1 , Ilona W M Verburg  2 , Ineke Dumaij  1 , Jacqueline Stouthard  3 , Johannes W R Nortier  4 , Dick Richel  5 , Eric P A van der Zwan  2 , Nicolette F de Keizer  2 , Evert de Jonge  6
Affiliations

Intensive care admission of cancer patients: a comparative analysis

Monique M E M Bos et al. Cancer Med. 2015 Jul.

Abstract

The aim of this study was to obtain insight into which proportion of cancer patients is admitted to an Intensive Care Unit (ICU) and how their survival, demographic, and clinical characteristics relate to cancer patients not admitted to the ICU. Data from patients registered with cancer between 2006 and 2011 in four hospitals in the Netherlands were linked to the Dutch National Intensive Care Evaluation registry. About 36,860 patients with cancer were identified, of whom 2,374 (6.4%) were admitted to the ICU. Fifty-six percent of ICU admissions were after surgery, whereas 44% were for medical reasons. The risk for ICU admission was highest among cancer patients treated with surgery either alone or combined with chemotherapy and/or radiation therapy. Only 80 of 1,073 medical ICU admissions (3.3%) were for cancer-specific reasons. Although more women (54.0%) than men were registered with cancer, the proportion of male cancer patients admitted to an ICU was much higher (9.3 vs. 4.0%, P < 0.001). Five-year survival of cancer patients admitted to the ICU was substantial (41%) although median survival was much lower (1,104 days) than in patients not admitted to the ICU (median survival time not reached, P < 0.001). These results show that one out of 16 cancer patients was admitted to an ICU and that ICU support for this group should not be considered futile.

Keywords: Age differences; cancer; gender differences; intensive care; survival.

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Figures

Figure 1
Figure 1
Kaplan–Meier curve for time until intensive care unit admission for all cancer diagnoses. The graph shows the time to ICU admission from opening of the diagnosis treatment combination for all 40,716 cancer diagnoses.
Figure 2
Figure 2
Survival of cancer patients who were or were not admitted to the ICU. Survival of cancer patients who were (solid line) or who were not (dotted line) admitted to the ICU. This analysis encompassed 36,860 adult patients registered with a cancer diagnosis between January 1, 2006 and January 1, 2011 in four hospitals in the Netherlands. Of these patients, 2374 were admitted to the ICU during the study period. The graph shows Kaplan–Meier curves starting at the date of cancer diagnosis registration; p value indicates the difference between groups.
Figure 3
Figure 3
Kaplan–Meijer survival curves of cancer patients admitted to the ICU according to type of cancer. (A) Lung cancer, (B) Head and neck cancer, (C) Colorectal cancer, (D) Pancreatic and biliary cancer, (E) Esophageal cancer, (F) Other types of gastrointestinal cancer, (G) Urinary tract cancer, (H) Hematological malignancy, (I) Breast cancer, (J) Prostate cancer.
Figure 4
Figure 4
Survival of patients admitted to an ICU coded as medical admission for cancer, surgical admission for cancer; or other admission diagnosis.
See this image and copyright information in PMC

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