Outcomes of elderly patients with stage IIIB-IV non-small cell lung cancer admitted to the intensive care unit.
BACKGROUND
Although the prognosis of elderly patients with stage IIIB and IV non-small cell lung cancer (NSCLC) is poor, it remains a common cause of cancer related admissions to the intensive care unit (ICU). The objective was to evaluate short and long-term outcomes of a population-based sample of elderly patients with advanced NSCLC who require ICU care.


METHODS
Using combined data from the Surveillance, Epidemiology and End Results registry and Medicare files, we identified 1134 patients >65 years of age with stage IIIB and IV NSCLC admitted to an ICU with a diagnosis of respiratory, cardiac, or neurologic complications, renal failure, or sepsis. We assessed rates and predictors of death during hospitalization. The Kaplan-Meier method was used to estimate mortality rates at 90 days and 1 year post hospital discharge.


RESULTS
In-hospital mortality was 33% (95% CI: 30-36%). The 90-day and 1-year mortality rate was 71% and 90%, respectively. Patients with an admitting diagnosis of sepsis had the highest rate of in-hospital mortality (59%). Of those who were alive at discharge, 52% were transferred to a skilled nursing facility, 6% to hospice, and 42% returned home.


CONCLUSIONS
We found that one-third of elderly patients with advanced NSCLC admitted to the ICU do not survive hospitalization. Among survivors, most patients required continued institutionalization with a very low likelihood of surviving >1 year from discharge. This data should help patients, families, and health care providers of elderly patients with advanced NSCLC make decisions regarding ICU utilization.
Divisions of Hematology-Oncology, Mount Sinai School of Medicine, New York, NY, USA.
Marcelo R
MR
Bonomi
Cardinale B
CB
Smith
Grace
G
Mhango
Juan P
JP
Wisnivesky
D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D007362:Intensive Care Units; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D008297:Male; D009367:Neoplasm Staging; D010343:Patient Admission; D018426:SEER Program; D016896:Treatment Outcome