Characteristics and outcomes of patients with solid tumors receiving chemotherapy in the intensive care unit

David J. Shaz, Stephen M. Pastores, Debra A. Goldman, Natalie Kostelecky, Richard F. Tizon, Kay See Tan, Neil A. Halpern

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

Abstract

Abstract: Purpose: The objective of this study was to evaluate the short- and long-term outcomes of adult patients with solid tumors receiving chemotherapy in the intensive care unit (ICU). Methods: This was a retrospective single-center study comparing the outcomes of patients with solid tumors who received chemotherapy in the ICU with a matched cohort of ICU patients (by age, sex, and tumor type) who did not receive chemotherapy. Conditional logistic regression and shared frailty Cox regression were used to assess short-term (ICU and hospital) mortality and death by 12-month post-hospital discharge, respectively. Results: Seventy-three patients with solid tumors who received chemotherapy in the ICU were successfully matched. The most common solid tumors included thoracic (30%), genitourinary (26%), and breast (16%). The ICU, hospital, and 12-month (post discharge) mortality rates of patients who recieved chomtherapy in the ICU were 23%, 36%, and 43%, respectively. When compared to the matched cohort of patients who did not receive chemotherapy, patients who received chemotherapy had a significantly longer length of stay in the ICU (median 7 vs. 4 days, p < 0.001) and hospital (median 15 vs. 11 days, p = 0.011) but similar short-term ICU and hospital mortality rates (23% vs. 18% and 36% vs. 38%, respectively). Patients who received chemotherapy in the ICU were at a lower risk of death by 12 months (HR 0.31, p < 0.001) compared to the matched cohort on multivariable analysis. Conclusions: Patients with solid tumors who received chemotherapy had increased ICU and hospital length of stay compared to patients who did not. Although short-term mortality did not differ, patients who received chemotherapy in the ICU had improved long-term survival. Our data can inform critical care triage decisions to include patients who are to receive chemotherapy in the ICU.

Original languageEnglish
Pages (from-to)3855-3865
Number of pages11
JournalSupportive Care in Cancer
Volume28
Issue number8
DOIs
StatePublished - 1 Aug 2020
Externally publishedYes

Keywords

  • Cancer
  • Chemotherapy
  • Intensive care unit
  • Outcomes
  • Solid tumors

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