Assumptions about Survival for Patients With Cancer Should Not Influence ICU Admission Decisions
In the short term, patients in the ICU with solid malignancies had favorable survival outcomes compared to all other ICU patients.
Though some evidence suggests that intensive care unit (ICU) departments are hesitant to admit patients with cancer — fueled by the notion that these patients will have a poor prognosis — new research published in JAMA Oncology suggests that patients requiring surgery for solid tumors in the ICU are not worse off when it comes to survival compared with other types of patients in the same department.1 In fact, in the short term, patients with cancer tended to have slightly lower mortality rates than the all-cause mortality numbers seen in the surgical ICU.
Researchers led by Kathryn Puxty, MD, of the Glasgow Royal Infirmary in the United Kingdom, looked specifically at data from 25,017 patients within 4 linked data sets: the Scottish Cancer Registry, Scottish Morbidity Record 01, national death records, and the Scottish Intensive Care Society Audit Group WardWatcher ICU database. They examined surgical patient deaths across those data banks from 2000 to 2011, looking specifically at how deaths of cancer patients with solid tumors compared with deaths of patients who had no malignancies upon admittance.
Though survival appeared to be better in patients with a solid tumor diagnosis than in all other patients in the ICU (mortality rates of 12.2% and 16.8%, respectively, P < .001), this trend only stuck within the first 6 months of analysis. After 6 months, the survival advantage switched over to the noncancer group. Further, after 4 years the difference in survival between the groups was much more marked: 39.1% for patients with cancer and 60.3% for patients without cancer.
The investigators presented the survival numbers to support the argument that clinical judgment about ICU admittance should be based on how critical an illness is, not on what tumor type or cancer type a patient has. “While clinicians should be aware that not all cancers are equal in terms of survival following surgical ICU admission, mortality rates are such that none of the tumor types should automatically preclude admission,” the researchers wrote.
- Puxty K, McLoone P, Quasim T et al. Characteristics and outcomes of surgical patients with solid cancers admitted to the intensive care unit [published online June 27, 2018]. JAMA Oncol. doi: 10.1001/jamasurg.2018.1571