With improving therapeutic options for advanced cancer, proportionally more patients are being admitted to the Intensive Care Unit (ICU) for disease or treatment-related complications1. Prognostic data pertaining to patients with advanced thoracic malignancies admitted to ICU are scarce. We evaluated the characteristics and outcomes of patients with advanced lung cancer admitted to a large metropolitan ICU.
Patients with advanced thoracic malignancies admitted to the ICU between January 2013 and July 2017 were retrospectively identified. Data regarding patient characteristics, survival, anticancer therapy and severity of illness were examined. All analyses were performed by IBM SPSS Statistics v26. Logistic regression was used to determine factors predictive of outcome.
Sixty-six patients were identified. 51 (77%) patients were diagnosed with non-small cell lung cancer, 14 (22%) with small cell lung cancer and one with mesothelioma. The median age was 63 years (range 47 - 81). Twelve (18%) patients had multiple ICU admissions. Main ICU admission indications were resection of cranial metastases or intracranial haemorrhage (51%), respiratory failure (14%), sepsis (8%), and cardiogenic shock (4%). Nineteen patients (29%) died within 30 days of their ICU admission and nine patients (14%) were discharged to higher level care facilities. Median overall survival was 245 days. Respiratory failure (OR 0.07; 95% CI 0.01 – 0.50; p=0.008) and chemotherapy within 30 days of ICU admission (OR 0.18; 95% CI 0.04 – 0.97; p=0.04) were risk factors for increased 3-month mortality, but not 30-day mortality. Neither sub-type of lung malignancy, antecedent radiotherapy or immunotherapy influenced mortality.
Factors associated with mortality of patients with thoracic malignancies admitted to the ICU were respiratory failure and antecedent chemotherapy. Given the improved prognosis of patients with thoracic malignancies, further studies of which patients are most likely to benefit from admission to ICU are needed.