PURPOSE: To retrospectively determine mortality rate of inoperable nonsmall cell lung cancer patients who present to the hospital with respiratory failure. To identify predictors of mortality at the time of hospital admission.
METHODS: Study population- nonsmall cell lung cancer patients admitted to USC Norris Cancer Hospital/University Hospital System for the period 1990-2008 meeting the following criteria: 1. Diagnosis of nonsmall cell lung cancer considered inoperable/unresectable or failed previous curative intent surgery 2. Admitted for or developing during hospitalization respiratory failure (not counting elective intubations) defined as need for mechanical or noninvasive ventilation or FiO2 requirements of 50% or higher. Collected data: Demographics, type of nonsmall cell lung cancer, time since diagnosis of lung cancer, stage at the time admission (UICC TNM staging 6th edition), reason for respiratory failure, APACHE-II at admission or onset of respiratory failure, evidence of CO2 retention. Primary outcome: Short-term mortality defined as death while in the hospital or within 3 months of discharge as well as discharge to Hospice. Secondary goal: Identify risk factors among the collected clinical data by performing a regression analysis.
RESULTS: 17 patients met the study criteria. Only 1 patient was alive 3 months after discharge. That patient expired 4 months after leaving the hospital. Due to this universally poor outcome, no regression analysis could be performed seeking to identify mortality predictors.
CONCLUSION: The mortality rate of patients with incurable nonsmall cell lung cancer admitted for respiratory failure or developing respiratory failure during their hospital stay appears to be close to 100%.
CLINICAL IMPLICATIONS: Both the financial cost and the emotional toll on families during the patients’ end-of-life period is enormous. By having an ability to better predict the outcome in well defined clinical scenarios, medical professionals should be able to better prepare the patients and their family as well as themselves for an unfavorable outcome. More available outcome data will allow for better utilizing of health care resources especially during the extremely costly end-of-life period.
DISCLOSURE: Boris Medarov, No Financial Disclosure Information; No Product/Research Disclosure Information