Characteristics and outcomes of patients with solid tumors receiving chemotherapy in the intensive care unit

Abstract

Purpose

The objective of this study was to evaluate the short- and long-term outcomes of adult patients with solid tumors receiving chemotherapy in the intensive care unit (ICU).

Methods

This was a retrospective single-center study comparing the outcomes of patients with solid tumors who received chemotherapy in the ICU with a matched cohort of ICU patients (by age, sex, and tumor type) who did not receive chemotherapy. Conditional logistic regression and shared frailty Cox regression were used to assess short-term (ICU and hospital) mortality and death by 12-month post-hospital discharge, respectively.

Results

Seventy-three patients with solid tumors who received chemotherapy in the ICU were successfully matched. The most common solid tumors included thoracic (30%), genitourinary (26%), and breast (16%). The ICU, hospital, and 12-month (post discharge)  mortality rates of patients who recieved chomtherapy in the ICU were 23%, 36%, and 43%, respectively. When compared to the matched cohort of patients who did not receive chemotherapy, patients who received chemotherapy had a significantly longer length of stay in the ICU (median 7 vs. 4 days, p < 0.001) and hospital (median 15 vs. 11 days, p = 0.011) but similar short-term ICU and hospital mortality rates (23% vs. 18% and 36% vs. 38%, respectively). Patients who received chemotherapy in the ICU were at a lower risk of death by 12 months (HR 0.31, p < 0.001) compared to the matched cohort on multivariable analysis.

Conclusions

Patients with solid tumors who received chemotherapy had increased ICU and hospital length of stay compared to patients who did not. Although short-term mortality did not differ, patients who received chemotherapy in the ICU had improved long-term survival. Our data can inform critical care triage decisions to include patients who are to receive chemotherapy in the ICU.

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Data availability

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Acknowledgments

We acknowledge the assistance of Gleb Kirnicinii, Senior Application Analyst, Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY for data management and pre-analysis.

Funding

This study was supported, in part, by the Core Grant (P30 CA008748) and the Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY.

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Affiliations

Authors

Contributions

Conception and design: Stephen M Pastores, David Shaz, Neil A Halpern.

Provision of study materials or patients: Stephen M Pastores, David Shaz, Neil A Halpern.

Collection and assembly of data: All authors.

Data analysis and interpretation: All authors.

Manuscript writing: All authors.

Final approval of manuscript: All authors.

Corresponding author

Correspondence to David J Shaz.

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The authors declare that they have no conflict of interest.

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Shaz, D.J., Pastores, S.M., Goldman, D.A. et al. Characteristics and outcomes of patients with solid tumors receiving chemotherapy in the intensive care unit. Support Care Cancer 28, 3855–3865 (2020). https://doi.org/10.1007/s00520-019-05226-w

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Keywords

  • Chemotherapy
  • Cancer
  • Solid tumors
  • Intensive care unit
  • Outcomes