Abstract
Background: There has been an overall decline in intensive care unit mortality over the past 2 decades, including in patients undergoing intubation and mechanical ventilation (MV). Whether this decline extends to patients with metastatic cancer remains unknown. We analyzed the outcomes of patients with metastatic cancer undergoing intubation/MV using the National Hospital Discharge Survey (NHDS) database from 2001 to 2010. Methods: Diagnosis and procedure codes were used to identify patients with metastatic cancer who underwent intubation/MV. Demographics, diagnoses, length of stay (LOS), and discharge information were abstracted. Multivariate linear and logistic regression models with weighted analysis were conducted to study trends in outcomes. Results: During the 10-year study period, 200,350 patients with metastatic cancer and who underwent intubation/MV were identified; the mean age was 65.3 years and 46.2% were men. There was an increase in the total number of patients with metastatic cancer who underwent intubation/MV during the study period, from 36,881 in 2001–2002 to 51,003 in 2009–2010 (P<.001). The overall inpatient mortality rate was 57.3%, discharge to a care facility (DTCF) rate was 40.9% among patients alive at discharge, and mean LOS was 11.1 days. No significant trends were seen in rates of mortality, DTCF, or LOS from 2001 to 2010. Conclusions: In this national database, there was an increase in the number of patients with metastatic cancer who underwent intubation/MV. These patients had high rates of inpatient mortality and DTCF, which did not improve during the study period. Therefore, novel solutions are required to improve outcomes for these patients.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 286-292 |
| Number of pages | 7 |
| Journal | JNCCN Journal of the National Comprehensive Cancer Network |
| Volume | 16 |
| Issue number | 3 |
| DOIs | |
| State | Published - Mar 1 2018 |
| Externally published | Yes |
Bibliographical note
Funding Information:Changes in ICU policies, improved ICU management, and early detection of sicker patients have led to overall improved ICU outcomes.4However, we found that improvements in overall cancer and ICU care have not translated into improved outcomes for patients with metastatic cancer requiring MV within the 10-year study period. This may be due to the inherently sicker nature of this population (requiring MV) versus all patients in the ICU. Patients with heart failure and stroke requiring intubation/MV in this study also did not show improved outcomes. Several factors associated with worse outcome, discussed earlier, may have been present in these patients. The increase in palliative care referral over time in patients with metastatic cancer who underwent intubation/MV, as demonstrated in our study, highlights the growing need and subsequent acknowledgement of the importance of palliative care in the management of these patients. The influx of research funding from multiple organizations, recognition of palliative care and hospice care by the American Board of Medical Specialties, and commencement of training of formal palliative care training programs by the Accreditation Council for Graduate Medical Education can partially explain the growing trend of palliative care referral in our study. This trend is also reflected in the National Palliative Care Registry, wherein a similar increment in palliative care has been demonstrated from 2001 to 2010.25 Patients who received palliative care in our study had higher mortality, which likely relates to the late referral to palliative care in the ICU and it being reserved for
Publisher Copyright:
© JNCCN—Journal of the National Comprehensive Cancer Network
