Do Elderly Patients With Non-hematologic Malignancies Have A Worse Outcome in the ICU?

Accepted 23 June 2009.

Summary

Background

The aim of this study was to evaluate the difference in outcome between older (≥ 65 years) and younger (< 65 years) cancer patients admitted to the intensive care unit (ICU) with acute life-threatening illness.

Methods

A total of 1,881 patients were admitted to the medical intensive care unit (ICU) of Mackay Memorial Hospital, Taipei, from September 2004 to September 2007. We excluded patients diagnosed with cancer and in remission for > 5 years, ICU stay of < 24 hours, and ICU admission for routine postoperative monitoring. A total of 85 patients were included and divided into younger (< 65 years) and older (≥ 65 years) groups for comparison.

Results

The mean ages of the younger and older group were 50.7 ± 3.6 years and 76.1 ± 1.9 years, respectively. There was no significance in ICU length of stay (8.6 ± 2.5 days vs. 11.7 ± 2.6 days; p = 0.09), in the proportion of high Adult Comorbidity Evaluation 27 grade (86.1% vs. 77.6%; p = 0.32). The most frequent reasons for ICU admission in the younger and older groups were acute respiratory failure (50.0% vs. 61.2%) and shock (41.7% vs. 24.5%). The elderly had significantly more sepsis (87.8% vs. 58.3%; p = 0.002) and bloodstream or intraperitoneal infection (34.7% vs. 13.9%; p = 0.03), and received earlier conventional mechanical ventilation (−0.3 ± 0.17 days vs. 0.13 ± 0.36 days; p = 0.045) and shorter vasopressor administration (2.07 ± 0.94 days vs. 5.36 ± 2.63 days; p = 0.03). The hospital survival times in younger and older groups were 36.3 ± 16.3 days and 60.9 ± 33.9 days (p = 0.20), respectively, and 1-year survival rates were 2.8% and 12.2% (p = 0.12), respectively.

Conclusion

The main cause of death and survival rates, both short-term and long-term, were not worse in elderly patients with non-hematologic malignancies in the ICU, and the main reasons for patient death were sepsis and respiratory failure, rather than the malignancy itself. Therefore, an ICU admission policy should not exclude elderly patients with non-hematologic malignancies merely because of concerns about survival rate or life expectancy.

Key Words: elderly , intensive care units , neoplasms , treatment outcome

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Article Outline

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• References

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References

1. 1 Department of Statistics, Ministry of the Interior, Taiwan. Monthly Bulletin of Interior Statistics in Taiwan, August 2008 . Available at: http://www.moi.gov.tw/stat/ [Accessed: August 2008]. .

2. 2 Council for Economic Planning and Development, Taiwan. Population Projection From 2004 to 2051 in Taiwan . Available at: http://www.cepd.gov.tw/m1.aspx [Accessed: August 2008]. .

3. 3 Department of Health, Executive Yuan, Taiwan. Statistics of Cause of Death in Taiwan, 2007 . Available at: http://www.doh.gov.tw/CHT2006 [Accessed: September 2008] .

4. 4 Schuster DP . Everything that should be done—not everything that can be done . Am Rev Respir Dis . 1992;145:508–509 . MEDLINE

5. 5 Carlon GC . Admitting cancer patients to the intensive care unit . Crit Care Clin . 1988;4:183–191 . MEDLINE

6. 6 Task Force of the American College of Critical Care Medicine, Society of Critical Care Medicine . Guidelines for intensive care unit admission, discharge, and triage . Crit Care Med . 1999;27:633–638 . MEDLINE | CrossRef

7. 7 Groeger J . Oncology and critical care [preface] . Crit Care Clin . 2001;17(3):xi–xii . Full Text | Full-Text PDF (81 KB) | CrossRef

8. 8 Sculier JP , Markiewicz E . Medical cancer patients and intensive care . Anticancer Res . 1991;11:2171–2174 . MEDLINE

9. 9 Le Gall JR , Klar J , Lemeshow S , et al. The Logistic Organ Dysfunction system: a new way to assess organ dysfunction in the intensive care unit. ICU Scoring Group . JAMA . 1996;276:802–810 . MEDLINE

10. 10 Paleri V , Wight RG . Applicability of the adult comorbidity evaluation-27 and the Charlson indexes to assess comorbidity by notes extraction in a cohort of United Kingdom patients with head and neck cancer: a retrospective study . J Laryngol Otol . 2002;116:200–205 . MEDLINE

11. 11 Bone RC , Balk RA , Cerra FB , et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis: the ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine . Chest . 1992;101:1644–1655 . MEDLINE | CrossRef

12. 12 Azoulay E , Thiéry G , Chevret S , et al. The prognosis of acute respiratory failure in critically ill cancer patients . Medicine (Baltimore) . 2004;83:360–370 . MEDLINE | CrossRef

13. 13 Chalfin DB , Carlon GC . Age and utilization of intensive care unit resources of critically ill cancer patients . Crit Care Med . 1990;18:694–698 . MEDLINE | CrossRef

14. 14 Karamlou K , Nichols DJ , Nichols CR . Intensive care unit outcomes in elderly cancer patients . Crit Care Clin . 2003;19:657–675 . Full Text | Full-Text PDF (189 KB) | CrossRef

15. 15 Regazzoni CJ , Zamora RJ , Petrucci E , et al. Hospital and 1-year outcomes of septic syndromes in older people: a cohort study . J Gerontol A Biol Sci Med Sci . 2008;63:210–212 .

16. 16 Staudinger T , Stoiser B , Mullner M , et al. Outcome and prognostic factors in critically ill cancer patients admitted to the intensive care unit . Crit Care Med . 2000;28:1322–1328 . MEDLINE | CrossRef

17. 17 Christodoulou C , Rizos M , Galani E , et al. Performance status (PS): a simple predictor of short-term outcome of cancer patients with solid tumors admitted to the intensive care unit (ICU) . Anticancer Res . 2007;27:2945–2948 .

18. 18 Jones AS , Beasley N , Houghton D , et al. The effects of age on survival and other parameters in squamous cell carcinoma of the oral cavity, pharynx and larynx . Clin Otolaryngol . 1998;23:51–56 . MEDLINE

19. 19 Lecuyer L , Chevret S , Thiery G , et al. The ICU trial: a new admission policy for cancer patients requiring mechanical ventilation . Crit Care Med . 2007;35:808–814 . MEDLINE | CrossRef

20. 20 Azoulay E , Afessa B . The intensive care support of patients with malignancy: do everything that can be done . Intensive Care Med . 2006;32:3–5 . MEDLINE | CrossRef

21. 21 Azoulay E , Moreau D , Alberti C , et al. Predictors of short-term mortality in critically ill patients with solid malignancies . Intensive Care Med . 2000;26:1817–1823 . MEDLINE | CrossRef

22. 22 Sulmasy DP , He MK , McAuley R , et al. Beliefs and attitudes of nurses and physicians about do not resuscitate orders and who should speak to patients and families about them . Crit Care Med . 2008;36:1817–1822 . CrossRef

a Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan

b Mackay Medicine, Nursing and Management College, Taipei, Taiwan

Correspondence to: Dr Chien-Liang Wu, Division of Thoracic and Critical Care Medicine, Department of Internal Medicine, Mackay Memorial Hospital, 92, Section 2, Chung-Shan North Road, Taipei 104, Taiwan

PII: S1873-9598(10)70003-X

doi:10.1016/S1873-9598(10)70003-X

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