Chest
Volume 139, Issue 1, January 2011, Pages 101-108
Journal home page for Chest

Original Research
Critical Care
Use of Intensive Care in Patients With Nonresectable Lung Cancer

https://doi.org/10.1378/chest.09-2863Get rights and content

Background

Admission of patients with lung cancer to the ICU has been criticized. We evaluated whether ICU admission improved 3-month survival in patients with nonresectable lung cancer. Factors associated with survival were identified.

Methods

A retrospective study was conducted in consecutive nonsurgical patients with lung cancer admitted to three ICUs in France between 2000 and 2007, 2005 and 2007, and 2005 and 2006.

Results

We included 103 patients with a median (interquartile range) Simplified Acute Physiology Score II of 33 (25-46) and logistic organ dysfunction (LOD) score of 3 (1-4). Invasive mechanical ventilation was required in 41 (40%) patients. Sixty-three (61%) patients had metastasis and 26 (25%) an Eastern Cooperative Oncology Group performance status (ECOG-PS) > 2. The reason for ICU admission was acute respiratory failure in 58 (56%) patients. Three-month survival rate was 37% (95% CI, 28%-46%). By multivariate analysis, variables associated with mortality were ECOG-PS > 2 (hazard ratio [HR], 2.65; 95% CI, 1.43-4.88), metastasis at admission (HR, 1.90; 95% CI, 1.08-3.33), and worse LOD score (HR, 1.19; 95% CI, 1.08-1.32). An LOD score decrease over the first 72 h was associated with survival.

Conclusions

Survival in nonsurgical patients with lung cancer requiring ICU admission was 37% after 90 days. Our results provide additional evidence that ICU management may be appropriate in patients with nonresectable lung cancer and organ failure.

Section snippets

Study Design

We conducted a retrospective review of the medical charts of patients with lung cancer admitted to three tertiary-level hospital ICUs in France that manage large numbers of patients with cancer. In these three ICUs, patients with cancer are admitted only if they are eligible for potentially lifespan-extending anticancer treatment. The study was approved by the appropriate ethics committee (Comité d'éthique des Centres d'Investigation Clinique de l'inter-région Rhône-Alpes-Auvergne), which

Patient Characteristics

We included 105 patients; only two patients were excluded because of missing data. Table 1 reports the main characteristics of the remaining 103 patients. Median follow-up in survivors was 109 days (IQR, 33-227 days). At 3 months, 7 (7%) patients were lost to follow-up.

At referral for ICU admission, 32 (31%) patients were from the ED, eight (8%) were transported to the hospital from home by an emergency mobile unit, and 63 (61%) were from the hospital wards. Most of the patients had squamous

Discussion

Although our patients with nonresectable lung cancer had acceptable rates of ICU and in-hospital survival (69% and 52%, respectively), survival rates were substantially lower after 90 days and 1 year (37% and 12%, respectively). Patients with lung cancer who had a poor ECOG-PS at baseline or who developed multiorgan failure early after ICU admission had significantly higher mortality rates.

Nevertheless, our data suggest that ICU admission may produce meaningful benefits in some patients.

Conclusions

In a select population of patients with nonresectable lung cancer, ICU admission was followed by a 37% 90-day survival rate. This survival rate is similar to that reported in ICU patients with any type of malignant disease. Factors associated with survival were an ECOG-PS > 2, nonmetastatic disease, and an admission LOD score ≤ 3. ECOG-PS was the main prognostic factor, except when the acute disease was very severe. This study provides the first data on the course of organ dysfunction over the

Acknowledgments

Author contributions: Dr Toffart: contributed to the planning, writing, and editing of the manuscript.

Dr Minet: contributed to the planning, writing, and editing of the manuscript.

Dr Raynard: contributed to the planning, writing, and editing of the manuscript.

Dr Schwebel: contributed to the planning, writing, and editing of the manuscript.

Dr Hamidfar-Roy: contributed to the planning, writing, and editing of the manuscript.

Dr Diab: contributed to the planning, writing, and editing of the

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