title: Predictors of In-Hospital Mortality in Patients With Metastatic Cancer Receiving Specific Critical Care Therapies.
abstract: In-hospital mortality is high for critically ill patients with metastatic cancer. To help patients, families, and clinicians make an informed decision about invasive medical treatments, we examined predictors of in-hospital mortality among patients with metastatic cancer who received critical care therapies (CCTs).
  
  
  
  We used the 2010 California Healthcare Cost and Utilization Project: State Inpatient Databases to identify admissions of patients with metastatic cancer (age ≥18 years) who received CCTs, including invasive mechanical ventilation (IMV), tracheostomy, percutaneous endoscopic gastrostomy (PEG) tube, acute use of dialysis, and total parenteral nutrition (TPN). We first described the characteristics and outcomes of patients who received any CCTs. We then used multivariable logistic regression models with generalized estimating equations (to account for clustering within hospitals) to identify predictors of in-hospital mortality among patients who received any CCTs.
  
  
  
  For 2010, we identified 99,085 admissions among patients with metastatic cancer. Of these, 9,348 (9.4%) received any CCT during hospitalization; 50% received IMV, 15% PEG tube, 8% tracheostomy, 40% TPN, and 8% acute dialysis. Inpatient mortality was 30%. Of patients who received any CCT and survived to discharge, 27% were discharged to a skilled nursing facility. Compared with patients who died, costs of care were $3,019 higher for admissions in which patients survived the hospitalization. Predictors of in-hospital mortality included non-white race (vs whites), lack of insurance (vs Medicare), unscheduled admissions, principal diagnosis of infections (vs cancer-related), greater burden of comorbidities, end-stage renal disease, liver disease and lung cancer (vs other cancers).
  
  
  
  Although more studies are needed to better understand risks and benefits of specific treatments in the setting of specific cancer types, these data will help to inform decision-making for patients with metastatic cancer who become critically ill.
authors: From the Division of Hematology/Oncology, James P. Wilmot Cancer Institute, University of Rochester/Strong Memorial Hospital, Rochester, New York; Division of Hematology/Oncology, Department of Medicine, Baystate Medical Center, Springfield, Massachusetts; Department of Medicine, Tufts University School of Medicine, Springfield, Massachusetts; Center for Quality of Care Research, Baystate Medical Center, Springfield, Massachusetts; and Department of Biostatistics and Epidemiology, University of Massachusetts, Amherst, Massachusetts.
authors: Kah Poh
authors: KP
authors: Loh
authors: From the Division of Hematology/Oncology, James P. Wilmot Cancer Institute, University of Rochester/Strong Memorial Hospital, Rochester, New York; Division of Hematology/Oncology, Department of Medicine, Baystate Medical Center, Springfield, Massachusetts; Department of Medicine, Tufts University School of Medicine, Springfield, Massachusetts; Center for Quality of Care Research, Baystate Medical Center, Springfield, Massachusetts; and Department of Biostatistics and Epidemiology, University of Massachusetts, Amherst, Massachusetts.
authors: Ankit
authors: A
authors: Kansagra
authors: From the Division of Hematology/Oncology, James P. Wilmot Cancer Institute, University of Rochester/Strong Memorial Hospital, Rochester, New York; Division of Hematology/Oncology, Department of Medicine, Baystate Medical Center, Springfield, Massachusetts; Department of Medicine, Tufts University School of Medicine, Springfield, Massachusetts; Center for Quality of Care Research, Baystate Medical Center, Springfield, Massachusetts; and Department of Biostatistics and Epidemiology, University of Massachusetts, Amherst, Massachusetts.
authors: Meng-Shiou
authors: MS
authors: Shieh
authors: From the Division of Hematology/Oncology, James P. Wilmot Cancer Institute, University of Rochester/Strong Memorial Hospital, Rochester, New York; Division of Hematology/Oncology, Department of Medicine, Baystate Medical Center, Springfield, Massachusetts; Department of Medicine, Tufts University School of Medicine, Springfield, Massachusetts; Center for Quality of Care Research, Baystate Medical Center, Springfield, Massachusetts; and Department of Biostatistics and Epidemiology, University of Massachusetts, Amherst, Massachusetts. From the Division of Hematology/Oncology, James P. Wilmot Cancer Institute, University of Rochester/Strong Memorial Hospital, Rochester, New York; Division of Hematology/Oncology, Department of Medicine, Baystate Medical Center, Springfield, Massachusetts; Department of Medicine, Tufts University School of Medicine, Springfield, Massachusetts; Center for Quality of Care Research, Baystate Medical Center, Springfield, Massachusetts; and Department of Biostatistics and Epidemiology, University of Massachusetts, Amherst, Massachusetts.
authors: Penelope
authors: P
authors: Pekow
authors: From the Division of Hematology/Oncology, James P. Wilmot Cancer Institute, University of Rochester/Strong Memorial Hospital, Rochester, New York; Division of Hematology/Oncology, Department of Medicine, Baystate Medical Center, Springfield, Massachusetts; Department of Medicine, Tufts University School of Medicine, Springfield, Massachusetts; Center for Quality of Care Research, Baystate Medical Center, Springfield, Massachusetts; and Department of Biostatistics and Epidemiology, University of Massachusetts, Amherst, Massachusetts. From the Division of Hematology/Oncology, James P. Wilmot Cancer Institute, University of Rochester/Strong Memorial Hospital, Rochester, New York; Division of Hematology/Oncology, Department of Medicine, Baystate Medical Center, Springfield, Massachusetts; Department of Medicine, Tufts University School of Medicine, Springfield, Massachusetts; Center for Quality of Care Research, Baystate Medical Center, Springfield, Massachusetts; and Department of Biostatistics and Epidemiology, University of Massachusetts, Amherst, Massachusetts.
authors: Peter
authors: P
authors: Lindenauer
authors: From the Division of Hematology/Oncology, James P. Wilmot Cancer Institute, University of Rochester/Strong Memorial Hospital, Rochester, New York; Division of Hematology/Oncology, Department of Medicine, Baystate Medical Center, Springfield, Massachusetts; Department of Medicine, Tufts University School of Medicine, Springfield, Massachusetts; Center for Quality of Care Research, Baystate Medical Center, Springfield, Massachusetts; and Department of Biostatistics and Epidemiology, University of Massachusetts, Amherst, Massachusetts. From the Division of Hematology/Oncology, James P. Wilmot Cancer Institute, University of Rochester/Strong Memorial Hospital, Rochester, New York; Division of Hematology/Oncology, Department of Medicine, Baystate Medical Center, Springfield, Massachusetts; Department of Medicine, Tufts University School of Medicine, Springfield, Massachusetts; Center for Quality of Care Research, Baystate Medical Center, Springfield, Massachusetts; and Department of Biostatistics and Epidemiology, University of Massachusetts, Amherst, Massachusetts.
authors: Mihaela
authors: M
authors: Stefan
authors: From the Division of Hematology/Oncology, James P. Wilmot Cancer Institute, University of Rochester/Strong Memorial Hospital, Rochester, New York; Division of Hematology/Oncology, Department of Medicine, Baystate Medical Center, Springfield, Massachusetts; Department of Medicine, Tufts University School of Medicine, Springfield, Massachusetts; Center for Quality of Care Research, Baystate Medical Center, Springfield, Massachusetts; and Department of Biostatistics and Epidemiology, University of Massachusetts, Amherst, Massachusetts. From the Division of Hematology/Oncology, James P. Wilmot Cancer Institute, University of Rochester/Strong Memorial Hospital, Rochester, New York; Division of Hematology/Oncology, Department of Medicine, Baystate Medical Center, Springfield, Massachusetts; Department of Medicine, Tufts University School of Medicine, Springfield, Massachusetts; Center for Quality of Care Research, Baystate Medical Center, Springfield, Massachusetts; and Department of Biostatistics and Epidemiology, University of Massachusetts, Amherst, Massachusetts.
authors: Tara
authors: T
authors: Lagu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002140:California / Q000453:epidemiology / Q000208:ethnology; D003422:Critical Care / Q000379:methods; D016208:Databases, Factual; D005260:Female; D017048:Health Care Costs; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009369:Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000401:mortality* / Q000628:therapy*; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care; D010342:Patient Acceptance of Health Care; D010351:Patient Discharge; D011379:Prognosis