PURPOSE: The present prospective descriptive study was designed (1) to assess the patient population needing respirator support in ward setting at a premier state-run oncology institute in India, (2) to observe and analyze the course of their disease while on respirator, and (3) to co-ordinate better quality of life (QOL) measures in cancer patients at the institute based on the present study's outcomes.
METHODS: Beginning from March 2005, all cancer patients who were connected to respirator in the wards were enrolled in the present study. Our anesthesiology department at the cancer institute also has primary responsibility for airway management and mechanical ventilation in high dependency units of oncology wards. Pre-ventilation variables in cancer patients were assessed to judge the futility of mechanical ventilation in ward setting. Subsequently, patients were observed for disease course while on respirator. Final outcome with its etio-pathogenesis was correlated with predicted futility of mechanical ventilation.
RESULTS: Over a period of two years, 132 (46 female and 86 male) cancer patients with median age 40 yrs (range: 1–75 yrs) were connected to respirator in oncology wards. Based on the pre-ventilation variables and indications for respirator support, right prediction of medical futility and hospital discharge was made in 81% of patients. Underestimation and overestimation of survival to hospital discharge was made in 9% cases and 10% cases respectively.
CONCLUSION: Prediction of outcome in cancer patients needing respirator support can be made in more than 80% cases.
CLINICAL IMPLICATIONS: Mechanical ventilation in cancer patients is a critical issue. The unique set of complications observed in cancer patients and ever-changing course of disease makes it difficult to decide for/against the need of mechanical ventilation. These concerns are further accentuated by lack of adequately formulated Do-Not-Attempt-Resuscitation (DNAR) policies and advance directives. The high probability of correct outcome-prediction can be used to educate patients, and their families and primary physicians for well-informed and documented advance directives, formulated and regularly revised DNAR policies, and judicious utilization of respirator support for better QOL outcomes.
DISCLOSURE: Deepak Gupta, None.