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Original Research: Critical Care |

Aggressiveness of Intensive Care Use Among Patients With Lung Cancer in the Surveillance, Epidemiology, and End Results-Medicare RegistryICU Use Among Elderly Patients With Lung Cancer

Colin R. Cooke, MD; Laura C. Feemster, MD; Renda Soylemez Wiener, MD; Maya E. O’Neil, PhD; Christopher G. Slatore, MD
Author and Funding Information

From the Division of Pulmonary and Critical Care Medicine (Dr Cooke), Center for Healthcare Outcomes and Policy, Institute for Healthcare Innovation and Policy, Michigan Center for Integrative Research in Critical Care, University of Michigan, Ann Arbor, MI; the Division of Pulmonary and Critical Care Medicine (Dr Feemster), VA Puget Sound Healthcare System and University of Washington School of Medicine, Seattle, WA; Boston University School of Medicine (Dr Wiener), Boston, MA; Edith Nourse Rogers Memorial VA Hospital (Dr Wiener), Bedford, MA; Health Services Research and Development (Drs O’Neil and Slatore), and Section of Pulmonary and Critical Care Medicine (Dr Slatore), Portland VA Medical Center; and the Division of Pulmonary and Critical Care Medicine (Dr Slatore), Department of Medicine, Oregon Health and Science University, Portland, OR.

CORRESPONDENCE TO: Colin R. Cooke, MD, University of Michigan, Center for Healthcare Outcomes and Policy, 2800 Plymouth Rd, Bldg 16, Room 127W, Ann Arbor, MI 48109; e-mail: cookecr@umich.edu


FUNDING/SUPPORT: This work was supported in part by the Agency for Healthcare Research and Quality [Grant K08 HS020672 to Dr Cooke], the National Cancer Institute [Grant K07 CA138772 to Dr Wiener], the National Heart, Lung and Blood Institute [Grant K23 HL111116 to Dr Feemster], and the Department of Veterans Affairs [to Drs Wiener and Feemster].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;146(4):916-923. doi:10.1378/chest.14-0477
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BACKGROUND:  Approximately 65% of elderly patients with lung cancer who are admitted to the ICU will die within 6 months. Efforts to improve end-of-life care for this population must first understand the patient factors that underlie admission to the ICU.

METHODS:  We performed a retrospective cohort study examining all fee-for-service inpatient claims in the Surveillance, Epidemiology, and End Results (SEER)-Medicare registry for elderly patients (aged > 65 years) who had received a diagnosis of lung cancer between 1992 and 2005 and who were hospitalized for reasons other than resection of their lung cancer. We calculated yearly rates of ICU admission per 1,000 hospitalizations via room and board codes or International Classification of Diseases, Ninth Revision, Clinical Modification and diagnosis-related group codes for mechanical ventilation, stratified the rates by receipt of mechanical ventilation and ICU type (medical/surgical/cardiac vs intermediate), and compared these rates over time.

RESULTS:  A total of 175,756 patients with lung cancer in SEER were hospitalized for a reason other than surgical resection of their tumor during the study period, 49,373 (28%) of whom had at least one ICU stay. The rate of ICU admissions per 1,000 hospitalizations increased over the study period from 140.7 in 1992 to 201.7 in 2005 (P < .001). The majority of the increase in ICU admissions (per 1,000 hospitalizations) between 1992 and 2005 occurred among patients who were not mechanically ventilated (118.2 to 173.3, P < .001) and among those who were in intermediate ICUs (20.0 to 61.9, P < .001), but increased only moderately in medical/surgical/cardiac units (120.7 to 139.9, P < .001).

CONCLUSIONS:  ICU admission for patients with lung cancer increased over time, mostly among patients without mechanical ventilation who were largely cared for in intermediate ICUs.

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