To characterize patients who received chemotherapy during their intensive care unit (ICU) admission in a cancer hospital over a 5-year period.
All ICU admissions between October 1998 and September 2003 were identified from the institutional database and those who received chemotherapy while in the ICU were specifically targeted for further study. We compared demographic data between patients who received chemotherapy and those who did not. Variables assessed included age, gender, ICU length of stay (LOS), ICU mortality, post-ICU LOS to hospital discharge, and long-term mortality as of October 2004. We constructed a clinical model to distinguish four subsets of patients receiving chemotherapy: three classes of critically ill patients (illness due to their cancer, illness not due to their cancer, and illness due to other disease in a patient with no cancer) and one group of non-critically ill patients receiving high-risk chemotherapy.
There were 2,756 ICU admissions during the study period. Of these, 111 (4%) received chemotherapy representing 4.2% of ICU admissions annually. Though they had similar gender distribution, patients receiving chemotherapy were younger, had longer ICU LOS, higher ICU mortality, longer post-ICU LOS to hospital discharge, and higher long-term mortality than ICU patients who did not receive chemotherapy. (Table 1) Of the patients receiving chemotherapy, the majority (78.4%) were critically ill from their cancer. Less than 10% had critical illness unrelated to their cancer or were critically ill without cancer and 11.7% were not critically ill, but required ICU admission for high-risk chemotherapy. (Table 2).
ICU LOS and mortality, post-ICU LOS to hospital discharge and overall mortality were higher in cancer patients who received chemotherapy in the ICU than ICU patients who did not.. The majority of patients who received chemotherapy during their ICU admission were critically ill from their cancer.
Further analyses may identify patients for whom chemotherapy administration in the ICU is beneficial. Until then, we recommend careful patient selection.
Comparison of Chemotherapy and Non-Chemotherapy Receiving ICU PatientsChemotherapy patients (n=111)Non-Chemo-therapy (n=2,756)Age yr (M±SD)51.5±16.461.3±15.5Gender (%F:%M)43:5741:59ICU LOS days (M±SD)9.1±10.85.5±7.7ICU mortality (%)22.517.7Post-ICU LOS days (M±SD)23.4±22.413.6±16.5Mortality % (10/07/04)81.465.6Table 1—
Chemotherapy ModelsChemo groups (4)n (111)% of total nCritically illDue to their cancer8778.4Not due to their cancer76.3Non-cancer disease43.6Non-critically ill; receiving high-risk chemotherapy for their cancer1311.7
Nina Raoof, None.