Skip to main content

Advertisement

SpringerLink
Log in

Who should be admitted to the intensive care unit? The outcome of intensive care unit admission in stage IIIB–IV lung cancer patients

  • Original Paper
  • Published:
Medical Oncology Aims and scope Submit manuscript

Abstract

Critical care for advanced lung cancer patients is still controversial, and the appropriate method for the selection of patients who may benefit from intensive care unit (ICU) care is not clearly defined. We retrospectively reviewed the medical records of stage IIIB–IV lung cancer patients admitted to the medical ICU of a university hospital in Korea between 2003 and 2011. Of 95 patients, 64 (67 %) had Eastern Cooperative Oncology Group (ECOG) performance status (PS) ≥2, and 79 (84 %) had non-small-cell lung cancer. In total, 28 patients (30 %) were newly diagnosed or were receiving first-line treatment, and 22 (23 %) were refractory or bedridden. Mechanical ventilation was required in 85 patients (90 %), and ICU mortality and hospital mortality were 57 and 78 %, respectively. According to a multivariate analysis, a PaO2/FiO2 ratio <150 [odds ratio (OR) = 5.51, 95 % confidence interval (CI) 2.10–14.48, p = 0.001] was independently associated with ICU mortality, and an ECOG PS ≥2 (OR = 9.53, 95 % CI 2.03–44.85, p = 0.004) and a need for vasoactive agents (OR = 6.94, 95 % CI 1.61–29.84, p = 0.009) were independently associated with hospital mortality. Refractory or bedridden patients (n = 22) showed significantly poorer overall survival (11.0 vs. 29.0 days, p = 0.005). Among 21 patients who were discharged from the hospital, 11 (52 %) received further chemotherapy. Certain advanced lung cancer patients may benefit from ICU management. However, refractory patients and patients with a poor PS do not seem to benefit from ICU care. Oncologists should try to discuss palliative care and end-of-life issues in advance to avoid futile care.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Jung KW, Won YJ, Kong HJ, Oh CM, Seo HG, Lee JS. Cancer statistics in Korea: incidence, mortality, survival and prevalence in 2010. Cancer Res Treat. 2013;45(1):1–14.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  2. Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin. 2011;61(2):69–90.

    Article  PubMed  Google Scholar 

  3. Kress JP, Christenson J, Pohlman AS, Linkin DR, Hall JB. Outcome of critically ill patients in a university hospital setting. Am J Respir Crit Care Med. 1999;160(6):1957–61.

    Article  CAS  PubMed  Google Scholar 

  4. Carlon GC. Admitting cancer patients to the intensive care unit. Crit Care Clin. 1988;4:183–91.

    CAS  PubMed  Google Scholar 

  5. Schuster DP. Everything that should be done: not everything that can be done. Am Rev Respir Dis. 1992;145:508–9.

    Article  CAS  PubMed  Google Scholar 

  6. Pène F, Percheron S, Lemiale V, Viallon V, Claessens YE, Marqué S, Charpentier J, Angus DC, Cariou A, Chiche JD, Mira JP. Temporal changes in management and outcome of septic shock in patients with malignancies in the intensive care unit. Crit Care Med. 2008;36:690–6.

    Article  PubMed  Google Scholar 

  7. Ewer MS, Ali MK, Atta MS, Morice RC, Balakrishnan PV. Outcome of lung cancer patients requiring mechanical ventilation for pulmonary failure. JAMA. 1986;256(24):3364–6.

    Article  CAS  PubMed  Google Scholar 

  8. Boussat S, El’rini T, Dubiez A, Depierre A, Barale F, Capellier G. Predictive factors of death in primary lung cancer patients on admission to the intensive care unit. Intensive Care Med. 2000;26:1811–6.

    Article  CAS  PubMed  Google Scholar 

  9. Lin YC, Tsai YH, Huang CC, Hsu KH, Wang SW, Tsao TC, Lin MC. Outcome of lung cancer patients with acute respiratory failure requiring mechanical ventilation. Respir Med. 2004;98(1):43–51.

    Article  PubMed  Google Scholar 

  10. Reichner CA, Thompson JA, O’Brien S, Kuru T, Anderson ED. Outcome and code status of lung cancer patients admitted to the medical ICU. Chest. 2006;130:719–23.

    Article  PubMed  Google Scholar 

  11. Soares M, Darmon M, Salluh JI, Ferreira CG, Thiéry G, Schlemmer B, Spector N, Azoulay E. Prognosis of lung cancer patients with life-threatening complications. Chest. 2007;131:840–6.

    Article  PubMed  Google Scholar 

  12. Adam AK, Soubani AO. Outcome and prognostic factors of lung cancer patients admitted to the medical intensive care unit. Eur Respir J. 2008;31:47–53.

    Article  CAS  PubMed  Google Scholar 

  13. Roques S, Parrot A, Lavole A, Ancel PY, Gounant V, Djibre M, Fartoukh M. Six-month prognosis of patients with lung cancer admitted to the intensive care unit. Intensive Care Med. 2009;35:2044–50.

    Article  PubMed  Google Scholar 

  14. Toffart AC, Minet C, Raynard B, Schwebel C, Hamidfar-Roy R, Diab S, Quetant S, Moro-Sibilot D, Azoulay E, Timsit JF. Use of intensive care in patients with nonresectable lung cancer. Chest. 2011;139(1):101–8.

    Article  PubMed  Google Scholar 

  15. Bonomi MR, Smith CB, Mhango G, Wisnivesky JP. Outcomes of elderly patients with stage IIIB–IV non-small cell lung cancer admitted to the intensive care unit. Lung Cancer. 2012;77:600–4.

    Article  PubMed  Google Scholar 

  16. Andréjak C, Terzi N, Thielen S, Bergot E, Zalcman G, Charbonneau P, Jounieaux V. Admission of advanced lung cancer patients to intensive care unit: a retrospective study of 76 patients. BMC Cancer. 2011;11:159.

    Article  PubMed Central  PubMed  Google Scholar 

  17. Chou KT, Chen CS, Su KC, Hung MH, Hsiao YH, Tseng CM, Chen YM, Lee YC, Perng DW. Hospital outcomes for patients with stage III and IV lung cancer admitted to the intensive care unit for sepsis-related acute respiratory failure. J Palliat Med. 2012;15(11):1234–9.

    Article  PubMed  Google Scholar 

  18. Soubani AO, Ruckdeschel JC. The outcome of medical intensive care for lung cancer patients: the case for optimism. J Thorac Oncol. 2011;6:633–8.

    Article  PubMed  Google Scholar 

  19. Slatore CG, Cecere LM, Letourneau JL, O’Neil ME, Duckart JP, Wiener RS, Farjah F, Cooke CR. Intensive care unit outcomes among patients with lung cancer in the surveillance, epidemiology, and end results-medicare registry. J Clin Oncol. 2012;30(14):1686–91.

    Article  PubMed  Google Scholar 

  20. Sharma G, Freeman J, Zhang D, Goodwin JS. Trends in end-of-life ICU use among older adults with advanced lung cancer. Chest. 2008;133:72–8.

    Article  PubMed  Google Scholar 

  21. Ho TH, Barbera L, Saskin R, Lu H, Neville BA, Earle CC. Trends in aggressiveness of end-of-life cancer care in the universal health care system of Ontario Canada. J Clin Oncol. 2011;29(12):1587–91.

    Article  PubMed  Google Scholar 

  22. Temel JS, Greer JA, Muzikansky A, Gallagher ER, Admane S, Jackson VA, Dahlin CM, Blinderman CD, Jacobsen J, Pirl WF, Billings JA, Lynch TJ. Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med. 2010;363(8):733–42.

    Article  CAS  PubMed  Google Scholar 

  23. Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, Schein RM, Sibbald WJ. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Chest. 1992;101(6):1644–55.

    Article  CAS  PubMed  Google Scholar 

  24. Azoulay E, Afessa B. The intensive care support of patients with malignancy: do everything that can be done. Intensive Care Med. 2006;32:3–5.

    Article  PubMed  Google Scholar 

  25. Darmon M, Azoulay E. Critical care management of cancer patients: cause for optimism and need for objectivity. Curr Opin Oncol. 2009;21:318–26.

    Article  PubMed  Google Scholar 

  26. Little AG, Gay EG, Gaspar LE, Stewart AK. National survey of non-small cell lung cancer in the United States: epidemiology, pathology and patterns of care. Lung Cancer. 2007;57:253–60.

    Article  PubMed  Google Scholar 

  27. Lim T, Nam SH, Kim MS, Yoon KS, Kim BS. Comparison of medical expenditure according to types of hospice care in patients with terminal cancer. Am J Hosp Palliat Care. 2013;30(1):50–2.

    Article  PubMed  Google Scholar 

  28. Soares M, Caruso P, Silva E, Teles JM, Lobo SM, Friedman G, Dal-Pizzol F, Mello PV, Bozza FA, Silva UV, Torelly AP, Knibel MF, Rezende E, Netto JJ, Piras C, Castro A, Ferreira BS, Réa-Neto A, Olmedo PB, Salluh JI, Brazilian Research in Intensive Care Network (BRICNet). Characteristics and outcomes of patients with cancer requiring admission to intensive care units: a prospective multicenter study. Crit Care Med. 2010;38(1):9–15.

    Article  PubMed  Google Scholar 

  29. Mendoza V, Lee A, Marik PE. The hospital-survival and prognostic factors of patients with solid tumors admitted to an ICU. Am J Hosp Palliat Care. 2008;25:240–3.

    Article  PubMed  Google Scholar 

  30. Soares M, Salluh JI, Spector N, Rocco JR. Characteristics and outcomes of cancer patients requiring mechanical ventilatory support for >24 h. Crit Care Med. 2005;33(3):520–6.

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

The authors have declared no conflict of interest.

Author information

Authors and Affiliations

  1. Divisions of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 166 Gumi-ro, Bundang-gu, Songnam-si, Gyeonggi-do, 463-707, Republic of Korea

    Yu Jung Kim, Jin Won Kim, Hyun Chang, Jeong-Ok Lee, Keun-Wook Lee, Jee Hyun Kim, Soo-Mee Bang & Jong Seok Lee

  2. Divisions of Pulmonology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Songnam-si, Republic of Korea

    Young-Jae Cho, Jong Sun Park, Ho Il Yoon, Jae Ho Lee & Choon-Taek Lee

  3. National Cancer Center, Goyang-si, Republic of Korea

    Mi-Jung Kim

Authors
  1. Yu Jung Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mi-Jung Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Young-Jae Cho
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jong Sun Park
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jin Won Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hyun Chang
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jeong-Ok Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Keun-Wook Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Jee Hyun Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Ho Il Yoon
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Soo-Mee Bang
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Jae Ho Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Choon-Taek Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Jong Seok Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jong Seok Lee.

Additional information

Yu Jung Kim and Mi-Jung Kim have contributed equally to this work.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kim, Y.J., Kim, MJ., Cho, YJ. et al. Who should be admitted to the intensive care unit? The outcome of intensive care unit admission in stage IIIB–IV lung cancer patients. Med Oncol 31, 847 (2014). https://doi.org/10.1007/s12032-014-0847-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s12032-014-0847-1

Keywords

Search

Navigation