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Title: Survival and functional outcomes of patients with metastatic solid organ cancer admitted to the intensive care unit of a tertiary centre
Austin Authors: Ha, Francis J;Weickhardt, Andrew J ;Parakh, Sagun ;Vincent, Andrew D;Glassford, Neil J;Warrillow, Stephen J ;Jones, Daryl A 
Affiliation: Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
Department of Medical Oncology, Olivia Newton-John Cancer Research Institute, Austin Health, Heidelberg, Victoria, Australia
Freemason's Centre for Men's Health, Discipline of Medicine, University of Adelaide, Adelaide, SA, Australia
Department of Intensive Care, Austin Health, Heidelberg, Victoria, Australia
Issue Date: Jun-2017
Publication information: Critical Care and Resuscitation 2017; 19(2): 159-166
Abstract: OBJECTIVE: Metastatic solid organ cancer is associated with a poor prognosis, and admission of patients with these cancers to the intensive care unit remains a dilemma. We aimed to assess outcomesin a cohort of these patients who were admitted to the ICU of a general tertiary centre. DESIGN, SETTING AND PATIENTS: A retrospective observational study of patients with incurable metastatic solid organ malignancies who had unplanned admission to a tertiary hospital ICU between 1 January 2010 and 30 June 2015. MAIN OUTCOME MEASURES: Survival outcomes up to 1 year after ICU admission, and functional outcomes as measured by Eastern Cooperative Oncology Group (ECOG) grade up to 3 months after ICU discharge. We also determined rates of advance care planning documentation. RESULTS: A total of 101 patients were treated in the ICU during the study period. Hospital, 30-day and 1-year mortality rates were 35%, 41% and 77%, respectively, and the median survival was 2.3 months (95% CI, 1.1-3.9 months). On multivariable analysis, lowest albumin level (hazard ratio [HR], 1.10; 95% CI, 1.04-1.15) and highest white cell count (HR, 1.03; 95% CI, 1.00-1.07) were significant, although they were marginal predictors of poorer overall survival. Higher ECOG grade showed a trend towards significance (HR, 1.60; 95% CI, 0.94-2.73; P = 0.08). In patients alive and assessable at 1 month, 17/31 (55%) had functionally declined. At 3 months, 15/22 surviving patients (68%) had returned to their baseline, pre-ICU admission ECOG grade. Ninety per cent had no advance care directive and twothirds did not have a medical enduring power of attorney. CONCLUSIONS: Survival is poor in patients with metastatic cancer after emergent ICU admission, although functional state is often recovered by 3 months in surviving patients. Albumin level, white cell count and ECOG grade are simple prognostic markers of survival.
ORCID: 0000-0002-7240-4106
PubMed URL:
Type: Journal Article
Appears in Collections:Journal articles

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