The prognosis for patients with lung cancer is poor. Despite this, they are admitted to the medical intensive care unit (MICU). The goals of this study were threefold: to determine the outcome of these patients admitted to the MICU, to examine their code status on admission and prior to death and to determine which physician was responsible for the change in code status.
We conducted a retrospective analysis of all lung cancer patients admitted to the MICU at Georgetown University Hospital from July 2002 to March 2004. Demographic data was obtained as was information regarding the mortality, code status, how often it was changed and which physician was primarily involved in the discussion of code status.
41 patients with lung cancer were admitted 46 times to the MICU. The overall hospital mortality was 59%. The patients who required mechanical ventilation or had more advanced lung cancer had the worst prognosis with a mortality of 67% (p=0.018) and 81% (p<0.01) respectively. 76% of patients were full code on admission to the MICU. Subsequently the code status was changed in 43% of the cases. The pulmonary/critical care physician was involved in this change 94% of the time and was sole responsible in 59% of the cases.
This study confirms that patients with lung cancer have a high mortality when admitted to the MICU. Despite this, the majority is full code on admission. The pulmonary/critical care physicians play an important role in end of life decision making for lung cancer patients in the MICU. This involvement is likely due to the availability of these physicians in the MICU and also their sense of responsibility in maintaining and withdrawing life support.
End of life discussion should be an important aspect of the care of patients with lung cancer, especially those with stage IIIB and stage IV non-small cell or extensive small cell lung cancer as these stages carry the highest mortality when admitted to the MICU.
C.A. Reichner, None.