title: Intensive care in patients with lung cancer: a multinational study.
abstract: BACKGROUND
  Detailed information about lung cancer patients requiring admission to intensive care units (ICUs) is mostly restricted to single-center studies. Our aim was to evaluate the clinical characteristics and outcomes of lung cancer patients admitted to ICUs.
  
  
  METHODS
  Prospective multicenter study in 449 patients with lung cancer (small cell, n = 55; non-small cell, n = 394) admitted to 22 ICUs in six countries in Europe and South America during 2011. Multivariate Cox proportional hazards frailty models were built to identify characteristics associated with 30-day and 6-month mortality.
  
  
  RESULTS
  Most of the patients (71%) had newly diagnosed cancer. Cancer-related complications occurred in 56% of patients; the most common was tumoral airway involvement (26%). Ventilatory support was required in 53% of patients. Overall hospital, 30-day, and 6-month mortality rates were 39%, 41%, and 55%, respectively. After adjustment for type of admission and early treatment-limitation decisions, determinants of mortality were organ dysfunction severity, poor performance status (PS), recurrent/progressive cancer, and cancer-related complications. Mortality rates were far lower in the patient subset with nonrecurrent/progressive cancer and a good PS, even those with sepsis, multiple organ dysfunctions, and need for ventilatory support. Mortality was also lower in high-volume centers. Poor PS predicted failure to receive the initially planned cancer treatment after hospital discharge.
  
  
  CONCLUSIONS
  ICU admission was associated with meaningful survival in lung cancer patients with good PS and non-recurrent/progressive disease. Conversely, mortality rates were very high in patients not fit for anticancer treatment and poor PS. In this subgroup, palliative care may be the best option.
authors.affiliation: Post-Graduation Program, Instituto Nacional de Câncer, Rio de Janeiro; Department of Clinical Research, D'Or Institute for Research and Education, Rio de Janeiro, Brazil. Electronic address: marciosoaresms@gmail.com.
authors.forename: M
authors.initials: M
authors.lastname: Soares
authors.affiliation: Thoracic Oncology Unit.
authors.forename: A-C
authors.initials: AC
authors.lastname: Toffart
authors.affiliation: Medical Intensive Care Unit (ICU), Hôpital A. Michallon Chu de Grenoble, Grenoble, France.
authors.forename: J-F
authors.initials: JF
authors.lastname: Timsit
authors.affiliation: ICU, Hospital Maciel, Montevideo, Uruguay.
authors.forename: G
authors.initials: G
authors.lastname: Burghi
authors.affiliation: ICU, Instituto Medico Especializado Alexander Fleming, Buenos Aires, Argentina.
authors.forename: C
authors.initials: C
authors.lastname: Irrazábal
authors.affiliation: ICU, Royal Brompton NHS Foundation Trust, London; ICU, Royal Marsden Hospital, London, UK.
authors.forename: N
authors.initials: N
authors.lastname: Pattison
authors.affiliation: ICU, Hospital Clinico Universidad de Chile, Santiago, Chile.
authors.forename: E
authors.initials: E
authors.lastname: Tobar
authors.affiliation: ICU, Hospital A. C. Camargo, São Paulo.
authors.forename: B F C
authors.initials: BFC
authors.lastname: Almeida
authors.affiliation: ICU, Fundação Pio XII-Hospital do Câncer de Barretos, Barretos.
authors.forename: U V A
authors.initials: UVA
authors.lastname: Silva
authors.affiliation: ICU, Hospital Sírio Libanês, São Paulo, Brazil.
authors.forename: L C P
authors.initials: LCP
authors.lastname: Azevedo
authors.affiliation: ICU, Hôtel Dieu de Paris, Paris.
authors.forename: A
authors.initials: A
authors.lastname: Rabbat
authors.affiliation: ICU, Institut Mutualiste Montsouris, Paris.
authors.forename: C
authors.initials: C
authors.lastname: Lamer
authors.affiliation: Medical ICU, APHP-Hopital Tenon, Paris, France.
authors.forename: A
authors.initials: A
authors.lastname: Parrot
authors.affiliation: ICU, Instituto Nacional de Câncer-Hospital do Câncer I, Rio de Janeiro, Brazil.
authors.forename: V C
authors.initials: VC
authors.lastname: Souza-Dantas
authors.affiliation: Medical-Surgical ICU, Hospices Civils de Lyon Centre Hospitalier Lyon Sud, Lyon.
authors.forename: F
authors.initials: F
authors.lastname: Wallet
authors.affiliation: ICU, Gustave Roussy, Villejuif.
authors.forename: F
authors.initials: F
authors.lastname: Blot
authors.affiliation: Medical ICU, Hôpital de la Croix-Rousse, Lyon, France.
authors.forename: G
authors.initials: G
authors.lastname: Bourdin
authors.affiliation: ICU, Vitória Apart Hospital, Vitória, Brazil.
authors.forename: C
authors.initials: C
authors.lastname: Piras
authors.affiliation: Medical ICU, Groupe Hospitalier Pitié Salpêtrière, Paris.
authors.forename: J
authors.initials: J
authors.lastname: Delemazure
authors.affiliation: Surgical ICU, Hôpital A. Michallon Chu de Grenoble, Grenoble, France.
authors.forename: M
authors.initials: M
authors.lastname: Durand
authors.affiliation: ICU, Hospital de Clínicas, Montevideo, Uruguay.
authors.forename: D
authors.initials: D
authors.lastname: Tejera
authors.affiliation: Post-Graduation Program, Instituto Nacional de Câncer, Rio de Janeiro; Department of Clinical Research, D'Or Institute for Research and Education, Rio de Janeiro, Brazil.
authors.forename: J I F
authors.initials: JIF
authors.lastname: Salluh
authors.affiliation: Medical ICU, Saint-Louis Teaching Hospital, Paris, France.
authors.forename: E
authors.initials: E
authors.lastname: Azoulay
mesh_terms: D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000628:therapy*; D015331:Cohort Studies; D003422:Critical Care; D005260:Female; D006801:Humans; D008168:Lung / Q000473:pathology; D008175:Lung Neoplasms / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome
keywords: cancer-related complications; intensive care; lung cancer; multicenter study; outcome