Previous research has shown that some clinicians can be reluctant to admit patients with cancer to the ICU due to concerns about short and longer-term survival.
“When a patient develops a critical illness, a decision needs to be made regarding appropriateness of ICU admission,” says Dr. Puxty. “Due to the physical, emotional and financial costs associated, patients should only undergo ICU care if they are likely to benefit.”
For a study published in JAMA Surgery, Kathryn Puxty, MBChB, MRCP, FRCA, FFICM, MD, and colleagues sought to determine how features and outcomes vary for surgical patients with and without cancer admitted to the ICU. The researchers analyzed ICU audit records linked to hospitalization discharge summaries, cancer registrations, and death records from 2001 to 2011 to compare patient characteristics (age, sex, severity of illness, reason for admission, and organ support) and survival (ICU, hospital, 6 months, and 4 years).
“We demonstrated that a preceding diagnosis of cancer did not have a strong impact on hospital mortality and that illness severity, emergency hospitalization and age were more important factors,” says Dr. Puxty. “Contrary to previous studies, ICU patients with cancer had favorable short-term outcomes, presumably due to the specific nature of their critical illness, but this survival advantage disappeared by 6 months. In view of these findings, a diagnosis of cancer should not preclude admission to an ICU in surgical patients with solid tumors. Further work should be focused on individual cancers to determine which features have prognostic value in determining potential survival benefit from ICU admission.”