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Benefit or Burden?Sending Patients With Lung Cancer to the ICU: Sending Patients With Nonresectable Lung Cancer to the ICU FREE TO VIEW

David McAvoy Chooljian, MD, JD; Vincent Liu, MD
Author and Funding Information

From the Division of Pulmonary and Critical Care Medicine, Stanford University School of Medicine.

Correspondence to: David McAvoy Chooljian, MD, JD, Stanford University School of Medicine, Division of Pulmonary and Critical Care Medicine, 300 Pasteur Dr, Room H3143, Stanford, CA 94305-5236; e-mail: dcool@stanford.edu


Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2011 American College of Chest Physicians


Chest. 2011;140(2):558. doi:10.1378/chest.11-0451
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To the Editor:

In a recent issue of CHEST (January 2011), Toffart and colleagues1 reported the results of a retrospective study of patients with lung cancer admitted to ICUs at three tertiary care centers in France. The aim was to evaluate whether ICU admission improved 3-month survival rates in patients with nonresectable lung cancer. At 90 days, 63% of the patients had died; the authors concluded that although the overall survival rate was low, ICU care provided some patients with meaningful benefits—most prominently, increased time at home for those who survived to discharge. The authors also found that physiologic deterioration within 72 h of ICU admission (as measured by the logistic organ dysfunction score) was associated with worsened survival and suggested that such deterioration could identify patients for whom ICU care might be withdrawn.

We applaud the authors for reporting outcomes, especially those beyond hospitalization, among a group of patients often considered to have a dismal survival rate.2,3 Undoubtedly, survival is improved for nearly all critically ill patients transferred to the ICU who would otherwise succumb to organ failure; indeed, a randomized controlled trial to test this hypothesis would be unethical. However, beyond this broad stroke, we suggest that a more detailed quantification of improved survival depends on identifying a relevant comparator group. In this study, for example, an appropriate group might have been ICU patients without lung cancer who had similar reasons for admission and measures of cause-independent organ dysfunction—perhaps matched by logistic organ dysfunction scores.4,5 In this context, the independent effect of lung cancer on ICU patients’ survival might be more clearly defined.

As the authors themselves state, ICU care is burdensome. Thus, decisions about whether such care is justifiable depend on defining the potential benefits of ICU admission so that they can be balanced against its burdens. Ideally, armed with this knowledge, clinicians, patients, and families will be able to make plans at the most appropriate time: before such burdensome care is imposed.

Toffart A-C, Minet C, Raynard B, et al. Use of intensive care in patients with nonresectable lung cancer. Chest. 2011;1391:101-108. [CrossRef] [PubMed]
 
Reichner CA, Thompson JA, O’Brien S, Kuru T, Anderson ED. Outcome and code status of lung cancer patients admitted to the medical ICU. Chest. 2006;1303:719-723. [CrossRef] [PubMed]
 
Soares M, Salluh JI, Torres VB, Leal JV, Spector N. Short- and long-term outcomes of critically ill patients with cancer and prolonged ICU length of stay. Chest. 2008;1343:520-526. [CrossRef] [PubMed]
 
Le Gall JR, Klar J, Lemeshow S, et al; ICU Scoring Group ICU Scoring Group The Logistic Organ Dysfunction system. A new way to assess organ dysfunction in the intensive care unit. JAMA. 1996;27610:802-810. [CrossRef] [PubMed]
 
Le Gall JR, Lemeshow S, Saulnier F. A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. JAMA. 1993;27024:2957-2963. [CrossRef] [PubMed]
 

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References

Toffart A-C, Minet C, Raynard B, et al. Use of intensive care in patients with nonresectable lung cancer. Chest. 2011;1391:101-108. [CrossRef] [PubMed]
 
Reichner CA, Thompson JA, O’Brien S, Kuru T, Anderson ED. Outcome and code status of lung cancer patients admitted to the medical ICU. Chest. 2006;1303:719-723. [CrossRef] [PubMed]
 
Soares M, Salluh JI, Torres VB, Leal JV, Spector N. Short- and long-term outcomes of critically ill patients with cancer and prolonged ICU length of stay. Chest. 2008;1343:520-526. [CrossRef] [PubMed]
 
Le Gall JR, Klar J, Lemeshow S, et al; ICU Scoring Group ICU Scoring Group The Logistic Organ Dysfunction system. A new way to assess organ dysfunction in the intensive care unit. JAMA. 1996;27610:802-810. [CrossRef] [PubMed]
 
Le Gall JR, Lemeshow S, Saulnier F. A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. JAMA. 1993;27024:2957-2963. [CrossRef] [PubMed]
 
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