Advertisement

Intensive Care Medicine

, Volume 39, Issue 5, pp 889–898 | Cite as

Long-term outcomes and quality of life in critically ill patients with hematological or solid malignancies: a single center study

  • S. G. Oeyen
  • D. D. Benoit
  • L. Annemans
  • P. O. Depuydt
  • S. J. Van Belle
  • R. I. Troisi
  • L. A. Noens
  • P. Pattyn
  • J. M. Decruyenaere
Original

Abstract

Purpose

Data concerning long-term outcomes and quality of life (QOL) in critically ill cancer patients are scarce. The aims of this study were to assess long-term outcomes and QOL in critically ill patients with hematological (HM) or solid malignancies (SM) 3 months and 1  year after intensive care unit (ICU) discharge, to compare these with QOL before ICU admission, and to identify prognostic indicators of long-term QOL.

Methods

During a 1 year prospective observational cohort analysis, consecutive patients with HM or SM admitted to the medical or surgical ICU of a university hospital were screened for inclusion. Cancer data, demographics, co-morbidity, severity of illness, organ failures, and outcomes were collected. The QOL before ICU admission, 3 months, and 1 year after ICU discharge was assessed using standardized questionnaires (EuroQoL-5D, Medical Outcomes Study 36-item Short Form Health Survey). Statistical significance was attained at P < 0.05.

Results

There were 483 patients (85 HM, 398 SM) (64 % men) with a median age of 62 years included. Mortality rates of HM compared to SM were, respectively: hospital (34 vs. 13 %), 3 months (42 vs. 17 %), and 1 year (66 vs. 36 %) (P < 0.001). QOL declined at 3 months, but improved at 1 year although it remained under baseline QOL, particularly in HM. Older age (P = 0.007), severe comorbidity (P = 0.035), and HM (P = 0.041) were independently associated with poorer QOL at 1 year.

Conclusions

Long-term outcomes and QOL were poor, particularly in HM. Long-term expectations should play a larger role during multidisciplinary triage decisions upon referral to the ICU.

Keywords

Critically ill patient Long-term outcomes Hematological malignancy Solid tumor Quality of life 

Notes

Acknowledgments

The authors wishes to thank the study nurses Patrick De Baets, Patsy Priem, Jo Vandenbossche, and Daniella Van der Jeught for their tremendous help, motivation, and enthusiasm concerning inclusions, interviewing patients, and calling patients or relatives. They thank Dominique Vandijck, who did a great job in helping with the start-up and preparation of the study, inclusions of patients, calling relatives, and supervising data collection, while working on his PhD. The authors also thank Chris Danneels for his help in setting up the database. Dominique D. Benoit received a Senior Clinical Investigator grant from the Research Foundation Flanders, Belgium.

Conflicts of interest

The authors declare that they have no competing interests.

Supplementary material

134_2012_2791_MOESM1_ESM.doc (56 kb)
Supplementary material 1 (DOC 56 kb)
134_2012_2791_MOESM2_ESM.doc (60 kb)
Supplementary material 2 (DOC 59 kb)
134_2012_2791_MOESM3_ESM.doc (66 kb)
Supplementary material 3 (DOC 65 kb)
134_2012_2791_MOESM4_ESM.doc (40 kb)
Supplementary material 4 (DOC 39 kb)
134_2012_2791_MOESM5_ESM.doc (70 kb)
Supplementary material 5 (DOC 70 kb)

References

  1. 1.
    Azoulay E, Soares M, Darmon M, Benoit D, Pastores S, Afessa B (2011) Intensive care of the cancer patient: recent achievements and remaining challenges. Ann Intensive Care 1:5CrossRefPubMedGoogle Scholar
  2. 2.
    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) (2010) Characteristics and outcomes of patients with cancer requiring admission to intensive care units: a prospective multicenter study. Crit Care Med 38:9–15CrossRefPubMedGoogle Scholar
  3. 3.
    Benoit DD, Vandewoude KH, Decruyenaere JM, Hoste EA, Colardyn F (2003) Outcome and early prognostic indicators in patients with a hematologic malignancy admitted to the intensive care unit for a life-threatening complication. Crit Care Med 31:104–112CrossRefPubMedGoogle Scholar
  4. 4.
    Pène F, Percheron S, Lemiale V, Viallon V, Claessens YE, Marqué S, Charpentier J, Angus DC, Cariou A, Chiche J-D, Mira JP (2008) Temporal changes in management and outcome of septic shock in patients with malignancies in the intensive care unit. Crit Care Med 36:690–696CrossRefPubMedGoogle Scholar
  5. 5.
    Vandijck DM, Benoit DD, Depuydt PO, Offner FC, Blot SI, Van Tilborgh AK, Nollet J, Steel E, Noens LA, Decruyenaere JM (2008) Impact of recent intravenous chemotherapy on outcome in severe sepsis and septic shock patients with hematological malignancies. Intensive Care Med 34:847–855CrossRefPubMedGoogle Scholar
  6. 6.
    Darmon M, Thiery G, Ciroldi M, de Miranda S, Galicier L, Raffoux E, Le Gall JR, Schlemmer B, Azoulay E (2005) Intensive care in patients with newly diagnosed malignancies and a need for cancer chemotherapy. Crit Care Med 33:2488–2493CrossRefPubMedGoogle Scholar
  7. 7.
    Benoit DD, Depuydt PO, Vandewoude KH, Offner FC, Boterberg T, De Cock CA, Noens LA, Janssens AM, Decruyenaere JM (2006) Outcome in severely ill patients with hematological malignancies who received intravenous chemotherapy in the intensive care unit. Intensive Care Med 32:93–99CrossRefPubMedGoogle Scholar
  8. 8.
    Soares M, Salluh JI, Spector N, Rocco JR (2005) Characteristics and outcomes of cancer patients requiring mechanical ventilator support for >24 hrs. Crit Care Med 33:520–526CrossRefPubMedGoogle Scholar
  9. 9.
    Gristina GR, Antonelli M, Conti G, Ciarlone A, Rogante S, Rossi C, Bertolini G (2011) Noninvasive versus invasive ventilation for acute respiratory failure in patients with hematological malignancies; a 5 year multicenter observational survey. Crit Care Med 39:2232–2239CrossRefPubMedGoogle Scholar
  10. 10.
    Benoit DD, Hoste EA, Depuydt PO, Offner FC, Lameire NH, Vandewoude KH, Dhondt AW, Noens LA, Decruyenaere JM (2005) Outcome in critically ill medical patients treated with renal replacement therapy; comparison between patients with and those without haematological malignancies. Nephrol Dial Transpl 20:552–558CrossRefGoogle Scholar
  11. 11.
    Soares M, Salluh JI, Carvalho MS, Darmon M, Rocco JR, Spector N (2006) Prognosis of critically ill patients with cancer and acute renal dysfunction. J Clin Oncol 24:4003–4010CrossRefPubMedGoogle Scholar
  12. 12.
    Benoit DD, Hoste EA (2010) Acute kidney injury in critically ill patients with cancer. Crit Care Clin 26:151–179CrossRefPubMedGoogle Scholar
  13. 13.
    Soares M, Salluh JI, Torres VB, Leal JV, Spector N (2008) Short-and long-term outcomes of critically ill patients with cancer and prolonged ICU length of stay. Chest 134:520–526CrossRefPubMedGoogle Scholar
  14. 14.
    Merz TM, Schär P, Bühlmann M, Takala J, Rothen HU (2008) Resource use and outcome in critically ill patients with hematological malignancy: a retrospective cohort study. Crit Care 12:R75CrossRefPubMedGoogle Scholar
  15. 15.
    McGrath S, Chatterjee F, Whiteley C, Ostermann M (2010) ICU and 6-month outcome of oncology patients in the intensive care unit. Q J Med 103:397–403CrossRefGoogle Scholar
  16. 16.
    Mokart D, Etienne A, Esterni B, Brun JP, Chow-Chine L, Sannini A, Faucher M, Blache JL (2012) Critically ill cancer patients in the intensive care unit: short-term outcome and 1-year mortality. Acta Anaesthesiol Scand 56:178–189CrossRefPubMedGoogle Scholar
  17. 17.
    Rosolem MM, Rabello LS, Lisboa T, Caruso P, Costa RT, Leal JV, Salluh JI, Soares M (2012) Critically ill patients with cancer and sepsis: clinical course and prognostic factors. J Crit Care 27:301–307CrossRefPubMedGoogle Scholar
  18. 18.
    Bird GT, Farquhar-Smith P, Wigmore T, Potter M, Gruber PC (2012) Outcomes and prognostic factors in patients with haematological malignancy admitted to a specialist cancer intensive care unit: a 5 yr study. Br J Anaesth 108:452–459CrossRefPubMedGoogle Scholar
  19. 19.
    Oeyen SG, Vandijck DM, Benoit DD, Annemans L, Decruyenaere JM (2010) Quality of life after intensive care: a systematic review of the literature. Crit Care Med 38:2386–2400CrossRefPubMedGoogle Scholar
  20. 20.
    Cense HA, Hulscher JB, de Boer AG, Dongelmans DA, Tilanus HW, Obertop H, Sprangers MA, van Lanschot JJ (2006) Effects of prolonged intensive care unit stay on quality of life and long-term survival after transthoracic esophageal resection. Crit Care Med 34:354–362CrossRefPubMedGoogle Scholar
  21. 21.
    de Boer AG, Genovesi PI, Sprangers MA, Van Sandick JW, Obertop H, Van Lanschot JJ (2000) Quality of life in long-term survivors after curative transhiatal oesophagectomy for oesophageal carcinoma. Br J Surg 87:1716–1721CrossRefPubMedGoogle Scholar
  22. 22.
    Yau E, Rohatiner AZ, Lister TA, Hinds CJ (1991) Long term prognosis and quality of life following intensive care for life-threatening complications of haematological malignancy. Br J Cancer 64:938–942CrossRefPubMedGoogle Scholar
  23. 23.
    Oeyen S, Benoit D, Annemans L, Decruyenaere J (2010) Quality of life before, 3 months, and 1 year after ICU discharge. Crit Care Med 38:P587 (suppl December)Google Scholar
  24. 24.
    Charlson ME, Pompei P, Ales KL, Mackenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chron Dis 40:373–383CrossRefPubMedGoogle Scholar
  25. 25.
    Knaus WA, Draper EA, Wagner DP, Zimmerman JE (1985) Prognosis in acute organ-system failure. Ann Surg 202:685–693CrossRefPubMedGoogle Scholar
  26. 26.
    Vincent JL, Moreno R, Takala J, Willatts S, De Mendonça A, Bruining H, Reinhart CK, Suter PM, Thijs LG (1996) The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-related Problems of the European Society of Intensive Care Medicine. Intensive Care Med 22:707–710CrossRefPubMedGoogle Scholar
  27. 27.
    Ware JE Jr, Sherbourne CD (1992) The MOS-36 item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 30:473–483CrossRefPubMedGoogle Scholar
  28. 28.
    McHorny CA, Ware JE Jr, Raczek AE (1993) The MOS 36-item short-form health survey (SF-36): II. Psychometric and clinical tests of validity in measuring physical and mental health constructs. Med Care 31:247–263CrossRefGoogle Scholar
  29. 29.
    Chrispin PS, Scotton H, Rogers J, Lloyd D, Ridley SA (1997) Short-Form 36 in the intensive care unit: assessment of acceptability, reliability and validity of the questionnaire. Anaesthesia 52:15–23CrossRefPubMedGoogle Scholar
  30. 30.
    Angus DC, Carlet J (2002) Brussels Roundtable Participants (2003) Surviving Intensive Care: a report from the 2002 Brussels Roundtable. Intensive Care Med 29:368–377Google Scholar
  31. 31.
    The EuroQol Group (1990) EuroQOL—a new facility for the measurement of health-related quality of life. Health Policy 16:199–208CrossRefGoogle Scholar
  32. 32.
    Brazier J, Jones N, Kind P (1993) Testing the validity of the Euroqol and comparing it with the SF-36 health survey questionnaire. Qual Life Res 2:169–180CrossRefPubMedGoogle Scholar
  33. 33.
    Lamont EB, Christakis A (2001) Prognostic disclosure to patients with cancer near the end of life. Ann Intern Med 134:1096–1105PubMedGoogle Scholar
  34. 34.
    Lamb BW, Sevdalis N, Mostafid H, Vincent C, Green JS (2011) Quality improvement in multidisciplinary cancer teams: an investigation of teamwork and clinical decision-making and cross-validation of assessments. Ann Surg Oncol 18:3535–3543CrossRefPubMedGoogle Scholar
  35. 35.
    Audry S, Abel J, Blazeby JM, Falk S, Campbell R (2008) What oncologists tell patients about survivals benefits of chemotherapy and implications for informed consent: qualitative study. BMJ 337:a752CrossRefGoogle Scholar
  36. 36.
    Weeks JC, Catalano PJ, Cronin A, Finkelman MD, Mack JW, Keating NL, Schrag D (2012) Patients’ expectations about effects of chemotherapy for advanced cancer. N Engl J Med 367:1616–1625CrossRefPubMedGoogle Scholar
  37. 37.
    Lecuyer L, Chevret S, Guidet B, Aegerter P, Martel P, Schlemmer B, Azoulay E (2008) Case volume and mortality in haematological patients with acute respiratory failure. Eur Respir J 32:748–754CrossRefPubMedGoogle Scholar
  38. 38.
    Zuber B, Tran TC, Aegerter P, Grimaldi D, Charpentier J, Guidet B, Mira JP, Pene F (2012) Impact of case volume on survival of septic shock in patients with malignancies. Crit Care Med 40:55–62CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2012

Authors and Affiliations

  • S. G. Oeyen
    • 1
  • D. D. Benoit
    • 1
    • 2
  • L. Annemans
    • 3
  • P. O. Depuydt
    • 1
    • 2
  • S. J. Van Belle
    • 2
    • 4
  • R. I. Troisi
    • 2
    • 5
  • L. A. Noens
    • 2
    • 6
  • P. Pattyn
    • 2
    • 7
  • J. M. Decruyenaere
    • 1
    • 2
  1. 1.Department of Intensive Care Medicine 1K12ICGhent University HospitalGhentBelgium
  2. 2.Faculty of Medicine and Health SciencesGhent UniversityGhentBelgium
  3. 3.I-CHER Faculty of Medicine and Health SciencesGhent UniversityGhentBelgium
  4. 4.Department of Medical OncologyGhent University HospitalGhentBelgium
  5. 5.Department of General and Hepato-Biliary SurgeryGhent University HospitalGhentBelgium
  6. 6.Department of HematologyGhent University HospitalGhentBelgium
  7. 7.Department of Gastro-Intestinal SurgeryGhent University HospitalGhentBelgium

Personalised recommendations