ICU-related mortality may explain variations in cancer outcomes

Sep 9 2015

By Shreeya Nanda, Senior medwireNews Reporter

A Scottish population-based study has characterised the incidence of critical illness resulting in admission to an intensive care unit (ICU) during the first 2 years after a cancer diagnosis.

Approximately one in 20 cancer patients required intensive care, say David Morrison (University of Glasgow) and colleagues in JAMA Oncology, adding that “[t]he associated high mortality rate may make a significant contribution to overall cancer outcomes”.

Data from four linked datasets – the Scottish Cancer Registry, Scottish Morbidity Record 01, National Records of Scotland death records and WardWatcherICU – showed that of 118,541 patients diagnosed with a solid cancer between 2000 and 2009, 5.2% were admitted to the ICU with a critical illness within 2 years of diagnosis.

ICU admissions rose with increasing age, from 2.2% for patients in the 16 to 29 years age group to 6.3% for those aged between 60 and 69 years, with a further decline in older age groups.

Patients with small intestinal cancers had the highest cumulative incidence of critical illness, at 17.2%, followed by colorectal cancer patients, at 16.5%. Skin melanoma, breast and prostate cancer patients were at the other end of the scale, with cumulative incidences of 0.4%, 0.8% and 1.2%, respectively.

Of 6040 cancer patients with available data, 14.1% died in the ICU and 24.6% during the hospital stay in which an ICU admission occurred.

When stratified by cancer location, patients with primary cancers of unknown origin had the highest hospital mortality, at 72.5%, followed by those with lung and liver cancer, at 60.3% and 56.7%, respectively. By contrast, the proportion of deaths during the hospital stay was lowest in thyroid, head and neck, and kidney cancer patients with respective rates of 10.7%, 11.8% and 14.3%.

Hospital mortality was “often high among those with cancers with otherwise good prognoses, such as breast and colorectal cancer”, with rates of 29.9% and 20.1%, respectively, observe the researchers.

Noting that critical illness could help to explain variations in cancer survival, and the relatively low number of ICU beds in the UK compared with other developed countries, they conclude: “From our current results we cannot say whether greater provision of ICU beds would contribute to improvements in cancer survival in the United Kingdom.

“However, it might be hypothesized that if ICUs are effective in reducing mortality following a critical illness, increased surveillance for early signs of critical illness and greater capacity to offer ICU care to patients with cancer might be beneficial.”

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