title: Prognostic factors, long-term survival, and outcome of cancer patients receiving chemotherapy in the intensive care unit.
abstract: Prognostic factors and outcomes of cancer patients with acute organ failure receiving chemotherapy (CT) in the intensive care unit (ICU) are still incompletely described. We therefore retrospectively studied all patients who received CT in any ICU of our institution between October 2006 and November 2013. Fifty-six patients with hematologic (n = 49; 87.5 %) or solid (n = 7; 12.5 %) malignancies, of which 20 (36 %) were diagnosed in the ICU, were analyzed [m/f ratio, 33:23; median age, 47 years (IQR 32 to 62); Charlson Comorbidity Index (CCI), 3 (2 to 5); Simplified Acute Physiology Score II (SAPS II), 50 (39 to 61)]. The main reasons for admission were acute respiratory failure, acute kidney failure, and septic shock. Mechanical ventilation and vasopressors were employed in 34 patients (61 %) respectively, hemofiltration in 22 (39 %), and extracorporeal life support in 7 (13 %). Twenty-seven patients (48 %) received their first CT in the ICU. Intention of therapy was cure in 46 patients (82 %). Tumor lysis syndrome (TLS) developed in 20 patients (36 %). ICU and hospital survival was 75 and 59 %. Hospital survivors were significantly younger; had lower CCI, SAPS II, and TLS risk scores; presented less often with septic shock; were less likely to develop TLS; and received vasopressors, hemofiltration, and thrombocyte transfusions in lower proportions. After discharge, 88 % continued CT and 69 % of 1-year survivors were in complete remission. Probability of 1- and 2-year survival was 41 and 38 %, respectively. Conclusively, administration of CT in selected ICU cancer patients was feasible and associated with considerable long-term survival as well as long-term disease-free survival.
authors.affiliation: Department of Medicine I, Intensive Care Unit 13i2, Comprehensive Cancer Center, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
authors.forename: Philipp
authors.initials: P
authors.lastname: Wohlfarth
authors.forename: Thomas
authors.initials: T
authors.lastname: Staudinger
authors.forename: Wolfgang R
authors.initials: WR
authors.lastname: Sperr
authors.forename: Andja
authors.initials: A
authors.lastname: Bojic
authors.forename: Oliver
authors.initials: O
authors.lastname: Robak
authors.forename: Alexander
authors.initials: A
authors.lastname: Hermann
authors.forename: Klaus
authors.initials: K
authors.lastname: Laczika
authors.forename: Alexander
authors.initials: A
authors.lastname: Carlström
authors.forename: Katharina
authors.initials: K
authors.lastname: Riss
authors.forename: Werner
authors.initials: W
authors.lastname: Rabitsch
authors.forename: Marija
authors.initials: M
authors.lastname: Bojic
authors.forename: Paul
authors.initials: P
authors.lastname: Knoebl
authors.forename: Gottfried J
authors.initials: GJ
authors.lastname: Locker
authors.forename: Maria
authors.initials: M
authors.lastname: Obiditsch
authors.forename: Valentin
authors.initials: V
authors.lastname: Fuhrmann
authors.forename: Peter
authors.initials: P
authors.lastname: Schellongowski
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology / Q000628:therapy; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001317:Austria / Q000453:epidemiology; D016913:Blood Component Transfusion / Q000706:statistics & numerical data; D064146:Chemotherapy-Induced Febrile Neutropenia / Q000188:drug therapy / Q000209:etiology; D003422:Critical Care / Q000706:statistics & numerical data; D018572:Disease-Free Survival; D004211:Disseminated Intravascular Coagulation / Q000209:etiology; D015199:Extracorporeal Membrane Oxygenation / Q000706:statistics & numerical data; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use; D019337:Hematologic Neoplasms / Q000150:complications / Q000188:drug therapy / Q000401:mortality; D006440:Hemofiltration / Q000706:statistics & numerical data; D017052:Hospital Mortality; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D011379:Prognosis; D012074:Remission Induction; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012131:Respiratory Insufficiency / Q000209:etiology / Q000628:therapy; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012772:Shock, Septic / Q000188:drug therapy / Q000209:etiology / Q000628:therapy; D015275:Tumor Lysis Syndrome / Q000453:epidemiology / Q000209:etiology; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
chemical_list: D014662:Vasoconstrictor Agents; D016179:Granulocyte Colony-Stimulating Factor