Intensive care in patients with lung cancer: a multinational study

M Soares; A-C Toffart; J-F Timsit; G Burghi; C Irrazábal; N Pattison; E Tobar; B F C Almeida; U V A Silva; L C P Azevedo; A Rabbat; C Lamer; A Parrot; V C Souza-Dantas; F Wallet; F Blot; G Bourdin; C Piras; J Delemazure; M Durand; D Tejera; J I F Salluh; E Azoulay; Lung Cancer in Critical Care (LUCCA) Study Investigators

doi:10.1093/annonc/mdu234

Intensive care in patients with lung cancer: a multinational study

M Soares, A-C Toffart, J-F Timsit, G Burghi, C Irrazábal, N Pattison, E Tobar, B F C Almeida, U V A Silva, L C P Azevedo, A Rabbat, C Lamer, A Parrot, V C Souza-Dantas, F Wallet, F Blot, G Bourdin, C Piras, J Delemazure, M DurandD Tejera, J I F Salluh, E Azoulay, Lung Cancer in Critical Care (LUCCA) Study Investigators

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Abstract

BACKGROUND: Detailed information about lung cancer patients requiring admission to intensive care units (ICUs) is mostly restricted to single-center studies. Our aim was to evaluate the clinical characteristics and outcomes of lung cancer patients admitted to ICUs.

PATIENTS AND METHODS: Prospective multicenter study in 449 patients with lung cancer (small cell, n = 55; non-small cell, n = 394) admitted to 22 ICUs in six countries in Europe and South America during 2011. Multivariate Cox proportional hazards frailty models were built to identify characteristics associated with 30-day and 6-month mortality.

RESULTS: Most of the patients (71%) had newly diagnosed cancer. Cancer-related complications occurred in 56% of patients; the most common was tumoral airway involvement (26%). Ventilatory support was required in 53% of patients. Overall hospital, 30-day, and 6-month mortality rates were 39%, 41%, and 55%, respectively. After adjustment for type of admission and early treatment-limitation decisions, determinants of mortality were organ dysfunction severity, poor performance status (PS), recurrent/progressive cancer, and cancer-related complications. Mortality rates were far lower in the patient subset with nonrecurrent/progressive cancer and a good PS, even those with sepsis, multiple organ dysfunctions, and need for ventilatory support. Mortality was also lower in high-volume centers. Poor PS predicted failure to receive the initially planned cancer treatment after hospital discharge.

CONCLUSIONS: ICU admission was associated with meaningful survival in lung cancer patients with good PS and non-recurrent/progressive disease. Conversely, mortality rates were very high in patients not fit for anticancer treatment and poor PS. In this subgroup, palliative care may be the best option.

Original language	English
Pages (from-to)	1829-35
Number of pages	7
Journal	Annals of Oncology
Volume	25
Issue number	9
Early online date	20 Jun 2014
DOIs	https://doi.org/10.1093/annonc/mdu234
Publication status	Published - 1 Sept 2014

Keywords

Carcinoma, Non-Small-Cell Lung
Cohort Studies
Critical Care
Female
Humans
Lung
Lung Neoplasms
Male
Middle Aged
Prospective Studies
Severity of Illness Index
Treatment Outcome
Journal Article
Multicenter Study
Observational Study
Research Support, Non-U.S. Gov't

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10.1093/annonc/mdu234

ANNONC-2014-0637Accepted author manuscript, 932 KBLicence: CC BY

Cite this

Soares, M., Toffart, A.-C., Timsit, J.-F., Burghi, G., Irrazábal, C., Pattison, N., Tobar, E., Almeida, B. F. C., Silva, U. V. A., Azevedo, L. C. P., Rabbat, A., Lamer, C., Parrot, A., Souza-Dantas, V. C., Wallet, F., Blot, F., Bourdin, G., Piras, C., Delemazure, J., ... Lung Cancer in Critical Care (LUCCA) Study Investigators (2014). Intensive care in patients with lung cancer: a multinational study. Annals of Oncology, 25(9), 1829-35. https://doi.org/10.1093/annonc/mdu234

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title = "Intensive care in patients with lung cancer: a multinational study",

abstract = "BACKGROUND: Detailed information about lung cancer patients requiring admission to intensive care units (ICUs) is mostly restricted to single-center studies. Our aim was to evaluate the clinical characteristics and outcomes of lung cancer patients admitted to ICUs.PATIENTS AND METHODS: Prospective multicenter study in 449 patients with lung cancer (small cell, n = 55; non-small cell, n = 394) admitted to 22 ICUs in six countries in Europe and South America during 2011. Multivariate Cox proportional hazards frailty models were built to identify characteristics associated with 30-day and 6-month mortality.RESULTS: Most of the patients (71%) had newly diagnosed cancer. Cancer-related complications occurred in 56% of patients; the most common was tumoral airway involvement (26%). Ventilatory support was required in 53% of patients. Overall hospital, 30-day, and 6-month mortality rates were 39%, 41%, and 55%, respectively. After adjustment for type of admission and early treatment-limitation decisions, determinants of mortality were organ dysfunction severity, poor performance status (PS), recurrent/progressive cancer, and cancer-related complications. Mortality rates were far lower in the patient subset with nonrecurrent/progressive cancer and a good PS, even those with sepsis, multiple organ dysfunctions, and need for ventilatory support. Mortality was also lower in high-volume centers. Poor PS predicted failure to receive the initially planned cancer treatment after hospital discharge.CONCLUSIONS: ICU admission was associated with meaningful survival in lung cancer patients with good PS and non-recurrent/progressive disease. Conversely, mortality rates were very high in patients not fit for anticancer treatment and poor PS. In this subgroup, palliative care may be the best option.",

keywords = "Carcinoma, Non-Small-Cell Lung, Cohort Studies, Critical Care, Female, Humans, Lung, Lung Neoplasms, Male, Middle Aged, Prospective Studies, Severity of Illness Index, Treatment Outcome, Journal Article, Multicenter Study, Observational Study, Research Support, Non-U.S. Gov't",

author = "M Soares and A-C Toffart and J-F Timsit and G Burghi and C Irraz{\'a}bal and N Pattison and E Tobar and Almeida, {B F C} and Silva, {U V A} and Azevedo, {L C P} and A Rabbat and C Lamer and A Parrot and Souza-Dantas, {V C} and F Wallet and F Blot and G Bourdin and C Piras and J Delemazure and M Durand and D Tejera and Salluh, {J I F} and E Azoulay and {Lung Cancer in Critical Care (LUCCA) Study Investigators}",

note = "This is a pre-copyedited, author-produced version of an article accepted for publication in Annals of Oncology following peer review. The version of record M. Soares, et al, 'Intensive care in patients with lung cancer: a multinational study', Annals of Oncology, Vol. 25 (9): 1829-1835, September 2014, is available online at https://doi.org/10.1093/annonc/mdu234.",

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month = sep,

day = "1",

doi = "10.1093/annonc/mdu234",

language = "English",

volume = "25",

pages = "1829--35",

journal = "Annals of Oncology",

issn = "0923-7534",

publisher = "Oxford University Press (OUP)",

number = "9",

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Soares, M, Toffart, A-C, Timsit, J-F, Burghi, G, Irrazábal, C, Pattison, N, Tobar, E, Almeida, BFC, Silva, UVA, Azevedo, LCP, Rabbat, A, Lamer, C, Parrot, A, Souza-Dantas, VC, Wallet, F, Blot, F, Bourdin, G, Piras, C, Delemazure, J, Durand, M, Tejera, D, Salluh, JIF, Azoulay, E & Lung Cancer in Critical Care (LUCCA) Study Investigators 2014, 'Intensive care in patients with lung cancer: a multinational study', Annals of Oncology, vol. 25, no. 9, pp. 1829-35. https://doi.org/10.1093/annonc/mdu234

TY - JOUR

T1 - Intensive care in patients with lung cancer

T2 - a multinational study

AU - Soares, M

AU - Toffart, A-C

AU - Timsit, J-F

AU - Burghi, G

AU - Irrazábal, C

AU - Pattison, N

AU - Tobar, E

AU - Almeida, B F C

AU - Silva, U V A

AU - Azevedo, L C P

AU - Rabbat, A

AU - Lamer, C

AU - Parrot, A

AU - Souza-Dantas, V C

AU - Wallet, F

AU - Blot, F

AU - Bourdin, G

AU - Piras, C

AU - Delemazure, J

AU - Durand, M

AU - Tejera, D

AU - Salluh, J I F

AU - Azoulay, E

AU - Lung Cancer in Critical Care (LUCCA) Study Investigators

N1 - This is a pre-copyedited, author-produced version of an article accepted for publication in Annals of Oncology following peer review. The version of record M. Soares, et al, 'Intensive care in patients with lung cancer: a multinational study', Annals of Oncology, Vol. 25 (9): 1829-1835, September 2014, is available online at https://doi.org/10.1093/annonc/mdu234.

PY - 2014/9/1

Y1 - 2014/9/1

N2 - BACKGROUND: Detailed information about lung cancer patients requiring admission to intensive care units (ICUs) is mostly restricted to single-center studies. Our aim was to evaluate the clinical characteristics and outcomes of lung cancer patients admitted to ICUs.PATIENTS AND METHODS: Prospective multicenter study in 449 patients with lung cancer (small cell, n = 55; non-small cell, n = 394) admitted to 22 ICUs in six countries in Europe and South America during 2011. Multivariate Cox proportional hazards frailty models were built to identify characteristics associated with 30-day and 6-month mortality.RESULTS: Most of the patients (71%) had newly diagnosed cancer. Cancer-related complications occurred in 56% of patients; the most common was tumoral airway involvement (26%). Ventilatory support was required in 53% of patients. Overall hospital, 30-day, and 6-month mortality rates were 39%, 41%, and 55%, respectively. After adjustment for type of admission and early treatment-limitation decisions, determinants of mortality were organ dysfunction severity, poor performance status (PS), recurrent/progressive cancer, and cancer-related complications. Mortality rates were far lower in the patient subset with nonrecurrent/progressive cancer and a good PS, even those with sepsis, multiple organ dysfunctions, and need for ventilatory support. Mortality was also lower in high-volume centers. Poor PS predicted failure to receive the initially planned cancer treatment after hospital discharge.CONCLUSIONS: ICU admission was associated with meaningful survival in lung cancer patients with good PS and non-recurrent/progressive disease. Conversely, mortality rates were very high in patients not fit for anticancer treatment and poor PS. In this subgroup, palliative care may be the best option.

AB - BACKGROUND: Detailed information about lung cancer patients requiring admission to intensive care units (ICUs) is mostly restricted to single-center studies. Our aim was to evaluate the clinical characteristics and outcomes of lung cancer patients admitted to ICUs.PATIENTS AND METHODS: Prospective multicenter study in 449 patients with lung cancer (small cell, n = 55; non-small cell, n = 394) admitted to 22 ICUs in six countries in Europe and South America during 2011. Multivariate Cox proportional hazards frailty models were built to identify characteristics associated with 30-day and 6-month mortality.RESULTS: Most of the patients (71%) had newly diagnosed cancer. Cancer-related complications occurred in 56% of patients; the most common was tumoral airway involvement (26%). Ventilatory support was required in 53% of patients. Overall hospital, 30-day, and 6-month mortality rates were 39%, 41%, and 55%, respectively. After adjustment for type of admission and early treatment-limitation decisions, determinants of mortality were organ dysfunction severity, poor performance status (PS), recurrent/progressive cancer, and cancer-related complications. Mortality rates were far lower in the patient subset with nonrecurrent/progressive cancer and a good PS, even those with sepsis, multiple organ dysfunctions, and need for ventilatory support. Mortality was also lower in high-volume centers. Poor PS predicted failure to receive the initially planned cancer treatment after hospital discharge.CONCLUSIONS: ICU admission was associated with meaningful survival in lung cancer patients with good PS and non-recurrent/progressive disease. Conversely, mortality rates were very high in patients not fit for anticancer treatment and poor PS. In this subgroup, palliative care may be the best option.

KW - Carcinoma, Non-Small-Cell Lung

KW - Cohort Studies

KW - Critical Care

KW - Female

KW - Humans

KW - Lung

KW - Lung Neoplasms

KW - Male

KW - Middle Aged

KW - Prospective Studies

KW - Severity of Illness Index

KW - Treatment Outcome

KW - Journal Article

KW - Multicenter Study

KW - Observational Study

KW - Research Support, Non-U.S. Gov't

U2 - 10.1093/annonc/mdu234

DO - 10.1093/annonc/mdu234

M3 - Article

C2 - 24950981

SN - 0923-7534

VL - 25

SP - 1829

EP - 1835

JO - Annals of Oncology

JF - Annals of Oncology

IS - 9

ER -

Intensive care in patients with lung cancer: a multinational study

Abstract

Keywords

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