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Critical illness, ICU admission common within 2 years of cancer diagnosis
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One in 20 patients were admitted to the ICU with a critical illness within 2 years of a cancer diagnosis, according to a retrospective observational study conducted in the United Kingdom.
Survival outcomes from most cancers tend to vary geographically, with poorer survival seen in the United Kingdom than other developed countries, according to study background.
David S. Morrison, MD, associate professor in the school of medicine in the institute of health and well-being at University of Glasgow, and colleagues sought to evaluate the risk for critical illness requiring ICU admission among patients with cancer. They identified 118,541 patients (median age, 69 years; interquartile range, 59-77; 52% women) diagnosed with solid tumor cancers using cancer registry data. Data included four datasets from 2000 to 20009 — with linked ICU admission data through 2011 — from 16 ICUs within the West of Scotland region of the United Kingdom.
Overall, 5.2% of the patients (95% CI, 5-5.3) developed a critical illness and were admitted to the ICU within 2 years.
The risk for critical illness was highest among patients aged 60 to 69 years (6.3%; 95% CI, 6.1-6.6) and was higher in men than women.
The cumulative incidence of critical illness appeared highest among patients with small intestine (17.2%; 95% CI, 13.3-21.8) and colorectal cancer (16.5%; 95% CI, 15.9-17.1).
Patients with breast cancer appeared to be at the lowest risk for critical illness requiring ICU admission (0.8%; 95% CI, 0.7-1).
In total, 14.1% (95% CI, 13.3-15) of the patients died while in the ICU and 24.6% (95% CI, 23.5-25.7) died during their hospital stay.
The mortality rate was highest among patients admitted through EDs (41.7%; 95% CI, 37.6-45.8) and was lowest among patients who underwent elective surgery (0.6%; 95% CI, 0.3-1.2). Socioeconomic status had no effect on risk for critical illness; however, researchers identified a higher mortality rate for patients from deprived areas (29.4%; 95% CI, 27.3-31.6) compared with those from the least-deprived areas (21.8%; 95% CI, 18.7-25.1).
This trend may be attributed to the fact that the United Kingdom has fewer ICU beds than most developed countries. There are 3.5 ICU beds per 100,000 population in the U.K., whereas France and Belgium have 3 to 6 times as many beds per person.
“From our current results we cannot say whether greater provision of ICU beds would contribute to the improvements in cancer survival in the U.K.,” Morrison and colleagues wrote. “However, it might be hypothesized that if ICUs are effective in reducing mortality following a critical illness, increased surveillance for early signs of critical illness and greater capacity to offer ICU care to patients with cancer might be beneficial.”
This study may help lay the groundwork to determine other profitable areas of study, such as quality-of-life outcomes, Knox H. Todd, MD, MPH, FACEP, professor and chair of the department of emergency medicine in the division of internal medicine at The University of Texas MD Anderson Cancer Center in Houston, wrote in an invited commentary.
“Ultimately, we must do our best to determine which patients with cancer benefit from admission to the ICU at a cost that is acceptable and sustainable within the economic constraints of a given region,” Todd wrote. “This study is a welcome incremental step toward better understanding the appropriate utilization of ICU care for those with cancer and we look forward to the future contributions of these researchers.” – by Anthony SanFilippo
Disclosure: The researchers and Todd report no relevant financial disclosures.
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