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Correspondence |

Critical Care Use in Patients With Lung CancerCritical Care Use in Patients with Lung Cancer FREE TO VIEW

Marcio Soares, MD, PhD; Luciano C. P. Azevedo, MD, PhD; Jorge I. F. Salluh, MD, PhD
Author and Funding Information

From D’Or Institute for Research and Education (Drs Soares and Salluh); the Postgraduate Program (Drs Soares and Salluh), Instituto Nacional de Câncer; and the Research and Education Institute (Dr Azevedo), Hospital Sírio-Libanês.

CORRESPONDENCE TO: Marcio Soares, MD, PhD, Rua Diniz Cordeiro, 30–3° andar. Botafogo, Rio de Janeiro, Brazil; e-mail:marciosoaresms@gmail.com


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Chest. 2015;147(2):e56-e57. doi:10.1378/chest.14-2299
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To the Editor:

In a recent issue of CHEST (October 2014), Cooke et al1 performed a secondary analysis using the Surveillance, Epidemiology, and End Results (SEER)-Medicare registry and demonstrated a significant increase in admissions of patients with lung cancer to intensive care and intermediate care units between 1992 and 2005. Interestingly, the increase in critical care use was more prominent in patients not mechanically ventilated and in intermediate care unit admissions. The study contributes significantly to the understanding of treatment aggressiveness among patients with lung cancer in the United States. In a previous study by the group using the same patient population, 65% of patients died within 6 months of ICU admission.2 More importantly in that study, mortality rates of 79% were reported in patients who were mechanically ventilated.2 However, as intrinsic limitations of using administrative data, the lack of information regarding relevant clinical characteristics (eg, performance status [PS]), goals of care provided (eg, full code, palliative care), and destination after ICU or hospital discharge imposes limitations for using the study results to assist in ICU triage decisions. Moreover, it is not clear in the study by Cooke et al1 whether patients admitted to intermediate units (32% of all studied patients) received palliative care as the main goal of care.1

Recently, our group evaluated 449 patients with lung cancer admitted to 22 ICUs in Europe and Latin America.3 We observed 6-month survival rates between 40% and 50% in patients with nonprogressive malignancy and good PS, even in case of sepsis, need for ventilatory support, or multiple organ dysfunction. Additionally, 71% of ICU survivors were at home at 6-month follow-up, and anticancer treatments were offered to almost one-half of them. Poor PS before ICU admission predicted the ability to receive chemotherapy in these patients. On the other hand, patients with poor PS and progressive cancer had mortality rates > 90%. We also observed comparable results in unselected patients with cancer requiring ventilatory support.4

The decision to admit a patient with lung cancer to the ICU is complex, involving multiple domains. In this process, taking into consideration only the underlying malignancy is no longer acceptable. Conversely, to recommend broad ICU admission policies to any patient is also unwise. Besides, avoiding unnecessary physical, psychologic, and emotional burden to patients and their relatives related to inappropriate decisions to offer or, conversely, deny ICU admission to patients with lung cancer should be paramount.5 If prognostic uncertainty is inherent to this process, we can improve it by promoting close collaboration and shared decisions among intensivists, oncologists, families, and, more importantly, patients themselves.

References

Cooke CR, Feemster LC, Wiener RS, O’Neil ME, Slatore CG. Aggressiveness of intensive care use among patients with lung cancer in the Surveillance, Epidemiology, and End Results-Medicare registry. Chest. 2014;146(4):916-923. [CrossRef] [PubMed]
 
Slatore CG, Cecere LM, Letourneau JL, et al. Intensive care unit outcomes among patients with lung cancer in the Surveillance, Epidemiology, and End Results-Medicare registry. J Clin Oncol. 2012;30(14):1686-1691. [CrossRef] [PubMed]
 
Soares M, Toffart A-C, Timsit J-F, et al; Lung Cancer in Critical Care (LUCCA) Study Investigators. Intensive care in patients with lung cancer: a multinational study. Ann Oncol. 2014;25(9):1829-1835. [CrossRef] [PubMed]
 
Azevedo LC, Caruso P, Silva UV, et al. Outcomes for patients with cancer admitted to the ICU requiring ventilatory support: results from a prospective multicenter study. Chest. 2014;146(2):257-266. [CrossRef] [PubMed]
 
Benoit DD, Soares M, Azoulay E. Has survival increased in cancer patients admitted to the ICU? We are not sure. Intensive Care Med. 2014;40(10):1576-1579. [CrossRef] [PubMed]
 

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References

Cooke CR, Feemster LC, Wiener RS, O’Neil ME, Slatore CG. Aggressiveness of intensive care use among patients with lung cancer in the Surveillance, Epidemiology, and End Results-Medicare registry. Chest. 2014;146(4):916-923. [CrossRef] [PubMed]
 
Slatore CG, Cecere LM, Letourneau JL, et al. Intensive care unit outcomes among patients with lung cancer in the Surveillance, Epidemiology, and End Results-Medicare registry. J Clin Oncol. 2012;30(14):1686-1691. [CrossRef] [PubMed]
 
Soares M, Toffart A-C, Timsit J-F, et al; Lung Cancer in Critical Care (LUCCA) Study Investigators. Intensive care in patients with lung cancer: a multinational study. Ann Oncol. 2014;25(9):1829-1835. [CrossRef] [PubMed]
 
Azevedo LC, Caruso P, Silva UV, et al. Outcomes for patients with cancer admitted to the ICU requiring ventilatory support: results from a prospective multicenter study. Chest. 2014;146(2):257-266. [CrossRef] [PubMed]
 
Benoit DD, Soares M, Azoulay E. Has survival increased in cancer patients admitted to the ICU? We are not sure. Intensive Care Med. 2014;40(10):1576-1579. [CrossRef] [PubMed]
 
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