Characteristics and outcomes of oncology unit patients requiring admission to an Australian intensive care unit

Outcome of Cancer Patients with an Unplanned Intensive Care Unit Admission: Predictors of Mortality and Long-term Survival

Background

Understanding the characteristics and outcomes of cancer patients with unplanned ICU admission is imperative for therapeutic decisions and prognostication purposes.

Objective

To describe the clinical characteristics of patients with hematological and non-hematological malignancies (NHM) who require unplanned ICU admission and to determine the predictors of mortality and long-term survival.

Methods

This retrospective study included all patients with cancer who had an unplanned ICU admission between 2011 and 2016 at a tertiary hospital in Saudi Arabia. The following variables were collected: age, gender, ICU length of stay (LOS), APACHE II score, type of malignancy, febrile neutropenia, source and time of admission, and need for mechanical ventilation (MV), renal replacement therapy (RRT), and treatment with vasopressors (VP). Predictors of mortality and survival rates at 28 days and 3, 6, and 12 months were calculated.

Results

The study included 410 cancer patients with 466 unplanned ICU admissions. Of these, 52% had NHM. The average LOS in the ICU was 9.6 days and the mean APACHE score was 21.9. MV was needed in 73% of the patients, RRT in 15%, and VP in 24%, while febrile neutropenia was present in 24%. There were statistically significant differences between survivors and non-survivors in the APACHE II score (17.7 ± 8.0 vs. 25.6 ± 9.2), MV use (52% vs. 92%), need for RRT (6% vs. 23%), VP use (42% vs. 85%), and presence of febrile neutropenia (18% vs. 30%). The predictors of mortality were need for MV (OR = 4.97), VP (OR = 3.43), RRT (OR = 3.31), and APACHE II score (OR = 1.10). Survival rates at 28 days, 3, 6, and 12 months were 52%, 28%, 22%, and 15%, respectively.

Conclusion

The survival rate of cancer patients with an unplanned admission to the ICU remains low. Predictors of mortality include need for MV, RRT, and VP and presence of febrile neutropenia. About 85% of cancer patients died within 1 year after ICU admission.

How Does Health-Related Quality of Life Change Over Time in Cancer Survivors Following an Admission to the Intensive Care Unit?: An Integrative Review

BACKGROUND

Cancer survivors account for 15% to 20% of all intensive care unit (ICU) admissions. In general ICU populations, patients are known to experience reduced health-related quality of life (HRQoL). However, little is known about HRQoL impacts among cancer survivors following a critical illness in ICU.

OBJECTIVE

The aim of this study was to critically synthesize the evidence to further understand the impact of a critical illness and ICU admission in cancer survivors.

METHODS

An integrative review was conducted and reported according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analysis) guidelines. Three electronic databases were searched (MEDLINE, CINAHL, and EMBASE) using keywords and Boolean logic. Quality appraisal, data extraction, and a narrative synthesis were completed for all included studies by 2 reviewers.

RESULTS

Eleven publications met inclusion criteria. Health-related quality-of-life domains most frequently reported in cancer survivors after discharge from ICU included the following: physical function limitations, physical symptoms, and anxiety/depression.

CONCLUSIONS

Health-related quality of life decreased immediately after the admission to ICU with a gradual increase in the 3 to 12 months following. Cancer survivors are vulnerable to physical limitations, pain, and social isolation after an admission to ICU.

IMPLICATIONS FOR PRACTICE

Cancer survivors who have been affected by a critical illness are at risk of reduced HRQoL after an admission to ICU. This integrative review will help clinicians and researchers to develop patient-centered models of care during the recovery of critical illness, which are currently lacking in service delivery.

Using machine learning algorithms to predict 28-day mortality in critically ill elderly patients with colorectal cancer

OBJECTIVE

To predict the 28-day mortality of critically ill, elderly patients with colorectal cancer (CRC) using five machine learning approaches.

METHODS

Data were extracted from the eICU Collaborative Research Database (eICU-CRD) (version 2.0) for a training cohort and from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) and Wuhan Union hospital for validation cohorts. Clinical information (i.e., demographics; initial laboratory tests; vital signs; outcomes) were collected. Five machine learning algorithms (LightGBM, decision tree, XGBoost, random forest, and ensemble model) and a logistic regression were applied for the prediction of 28-day mortality.

RESULTS

Overall, 693 patients were included from the eICU cohort, 181 patients from the MIMIC-IV cohort and 95 from the Wuhan Union cohort. Among the six machine learning models, the ensemble model exhibited the best predictive ability (AUC, 0.86), followed by random forest (AUC, 0.83) and LightGBM (AUC, 0.82) in the training cohort. The models also obtained the good predictive performance for the 28-day mortality in the validation cohorts.

CONCLUSIONS

We showed that machine learning algorithms can be used for the 28-day mortality prediction in critically ill, elderly patients with CRC.

Clinico-demographic and Outcome Predictors in Solid Tumor Patients with Unplanned Intensive Care Unit Admissions: An Observational Study

OBJECTIVES

Critically ill solid organ malignancy patients admitted to intensive care unit (ICU) as unplanned medical admissions behave differently from other subsets of cancer patients (hematolymphoid malignancies and cancer patients admitted for postoperative care). These patients if appropriately selected may benefit from the ICU care. There is paucity of data on critically ill unplanned admissions of solid organ malignancies from South Asia. We analyzed data of patients with solid tumors with unplanned admissions to the ICU to determine the clinical, epidemiological characteristics, and predictors of hospital mortality in an Indian ICU.

MATERIALS AND METHODS

This prospective, observational study was done in our 14-bedded mixed medical-surgical ICU from July 2014 to November 2015. We included all consecutive adult unplanned admissions with solid organ malignancies having ICU stay of >24 hours. Surgical admissions, hematolymphoid malignancies, advanced malignancy with no treatment options, and those cured of cancer >5 years were excluded.

RESULTS

Two hundred and thirty-five consecutive patients were included in this cohort. ICU and hospital mortalities were 36.6 and 40%, respectively. On multivariate analysis, cancer status [odds ratio (OR): 3.204; 95% confidence interval (CI): 1.271-8.078], invasive mechanical ventilation (OR: 5.940; 95% CI: 2.632-13.408), and sequential organ failure assessment (SOFA) score on the day of ICU admission (OR: 1.199; 95% CI: 1.042-1.379) were independent predictors of hospital mortality.

CONCLUSION

Acute respiratory failure and septic shock are the common reasons of unplanned ICU admission for patients with solid organ malignancies. With good patient selection, more than half of such patients are likely to be discharged alive from the hospital.

HOW TO CITE THIS ARTICLE

Siddiqui SS, Narkhede AM, Chaudhari HK, Ravisankar NP, Dhundi U, Sarode S, et al. Clinico-demographic and Outcome Predictors in Solid Tumor Patients with Unplanned Intensive Care Unit Admissions: An Observational Study. Indian J Crit Care Med 2021;25(12):1421-1426.

Occupational Therapy's Role with Oncology in the Acute Care Setting: A Descriptive Case Study

As individuals with cancer actively undergo medical treatment, they often experience profound impairments and side-effects that impact their physical and psychosocial functioning and well-being. As occupational therapy practitioners working in acute care, challenges when working with those with oncological diseases may include high acuity, impact on multiple body systems, and fluctuating symptom presentation and levels of function. Thus, it is critical for occupational therapy practitioners to be skilled in identifying and addressing the distinct needs of cancer survivors in the acute care setting. This manuscript presents a descriptive case study to highlight occupational therapy's role in cancer rehabilitation in the acute care setting.

[Cancer patients in the intensive care unit]

Over the past 20 years, demographic changes and a longer life expectancy of cancer patients has significantly increased the prevalence of this patient group in the intensive care unit (ICU). A fundamental finding is that acute organ dysfunction, rather than the underlying malignancy, determines the prognosis of ICU patients. While hematologic patients often suffer from a more severe disease course, patients with solid tumors do not present an increased hospital mortality compared to the normal population. As with other indications, the decision to transfer a cancer patient to an ICU should be made as soon as possible. While early transfer is associated with reduced hospital mortality, the presence of multiorgan failure on ICU admission is associated with increased mortality. Overall, the intensive care and hospital survival of critically ill hematologic or oncologic patients has improved over the last two decades and is now as high as 50 to 60%. After surviving an intensive care stay, one fifth of all patients have a good long-term prognosis. Thus, the former paradigm of general rejection of cancer patients for ICU care is no longer justified. For optimal care of cancer patients requiring intensive care, close cooperation between hematologists/oncologists and intensive care physicians is essential.

Triage and Prognostication of Cancer Patients Admitted to the Intensive Care Unit

Cancer remains a leading cause of morbidity and mortality. Advances in cancer screening, early detection, targeted therapies, and supportive care have led to improvements in outcomes and quality of life. The rapid increase in novel cancer therapies can cause life-threatening adverse events. The need for intensive care unit (ICU) care is projected to increase. Until 2 decades ago, cancer diagnosis often precluded ICU admission. Recently, substantial cancer survival has been achieved; therefore, ICU denial is not recommended. ICU resources are limited and expensive; hence, appropriate utilization is needed. This review focuses on triage and prognosis in critically ill cancer patients requiring ICU admission.

Practical Considerations for Treating Patients With Cancer in the COVID-19 Pandemic

Cancer has become a prevalent disease, affecting millions of new patients globally each year. The COVID-19 pandemic is having far-reaching impacts around the world, causing substantial disruptions to health and health care systems that are likely to last for a prolonged period. Early data have suggested that having cancer is a significant risk factor for mortality from severe COVID-19. A diverse group of medical oncologists met to formulate detailed practical advice on systemic anticancer treatments during this crisis. In the context of broad principles, issues including risks of treatment, principles of prioritizing resources, treatment of elderly patients, and psychosocial impact are discussed. Detailed treatment advice and options are given at a tumor stream level. We must maintain care for patients with cancer as best we can and recognize that COVID-19 poses a significant competing risk for death that changes conventional treatment paradigms.