Outcomes of Haematology/Oncology Patients Admitted to Intensive Care Unit (ICU) at The Canberra Hospital (TCH) — ASN Events

Outcomes of Haematology/Oncology Patients Admitted to Intensive Care Unit (ICU) at The Canberra Hospital (TCH) (#288)

Sagun Parakh 1 , Anna Piggin 1 , Terresa Neeman 2 , Imogen Mitchell 1 , Philip Crispin 1 , Alison Davis 1
  1. The Canberra Hospital, Canberra, ACT, Australia
  2. Australian National University, Canberra, ACT, Australia

Despite improved overall survival in patients (pts) with haematological and solid organ malignancies, they are often considered inappropriate for, and may be denied ICU admission when they clinically deteriorate. Recent studies show short-term outcomes of critically ill cancer pts admitted to ICU is better than previously reported [1], and comparable to critically ill patients with other chronic diseases [2].

This study examined outcomes of pts admitted to TCH ICU to explore whether ICU admission was justified and if a patient group more likely to benefit was detectable.

Retrospective study of pts with haematological and solid tumour malignancies non-electively admitted to TCH ICU, January 2008 - December 2012. Demographic data, baseline characteristics and post-ICU outcomes were collected and Kaplan-Meier estimates of survival calculated.

Of 223 pts, 128 had haematological malignancies, 95 solid tumours; 57% male, median age 50.2 years. Of solid tumour pts, 82% had metastatic disease and 55% were on palliative chemotherapy. Main reasons for ICU admission for haematological and solid malignancies (respectively) were sepsis (66% and 50%), respiratory distress (36% and 35%) and hypotension/shock (17% and 20%). Mean APACHE2 score was 21 and 18. The average length of stay in ICU was 4 days; 25% pts died in ICU; and 38% pts died during hospital stay. 48% were eventually discharged home. Post ICU median survival time was 68 days, with ~42% alive at 6 months. Patients with advanced disease did worse, but no significant difference in outcome by age.

Our study shows an in-hospital mortality rate, similar to other studies from general hospital settings [3]. Nearly half of pts were discharged home and alive at 6 months, making it likely their ICU admission was life prolonging. Further research needed to ensure appropriate pt selection for ICU and to explore quality of life post ICU.

  1. Song JU, Early intervention on the outcomes in critically ill cancer patients admitted to intensive care units. Intensive Care Medicine. 2012 Sep;38(9):1505-13
  2. Tanvetyanon T, Leighton JC. Life-sustaining treatments in patients who died of chronic congestive heart failure compared with metastatic cancer. Critical Care Medicine 2003, 31:60-64
  3. Mokart D. Et al. Critically ill cancer patients in the intensive care unit: short-term outcome and 1-year mortality. Acta Anaesthesiologica Scandinavica 2012; 56: 178–189