title: Withdrawing and Withholding Life Support in Patients With Cancer in an ICU Setting: A 5-Year Experience at a European Cancer Center.
abstract: OBJECTIVE
  This was an observational retrospective study aimed to examine the frequency and associated factors of withdrawing or withholding life support (WWLS) in the intensive care unit (ICU) of a comprehensive cancer center.
  
  
  METHODS
  Medical records of adult patients with cancer admitted to the ICU between January 2010 and December 2014 were reviewed. Patients who died during that period were classified into 2 groups: full life support and withdrawing and withholding life support. The relative impact of demographic and clinical factors was assessed using logistic regression.
  
  
  RESULTS
  A total of 247 patients died in our unit (mortality rate of 16.3%). Their median age was 62 (interquartile range [IQR] 51-73) years, there were 142 (57.5%) male patients, and they had predominantly solid malignancies (62.3%). The median Simplified Acute Physiology Score II and Acute Physiology and Chronic Health Evaluation scores were 67 (IQR 54-80) and 29 (IQR 23-55), respectively. Ninety-six (38.9%) patients died after WWLS with no statistically significant differences in decisions to limit therapy during the study period. Patients with advanced age, solid malignancies, nonneutropenic, and longer duration of mechanical ventilation were more likely to die after WWLS. In multivariate analysis, presenting with neutropenia was independently associated with a lower likelihood of dying after WWLS (odds ratio: 0.34, 95% confidence interval: 0.15-0.80).
  
  
  CONCLUSIONS
  Limitation of therapy has been a common practice in oncologic ICUs over recent years. Neutropenia is an independent predictor of limitation of therapy.
authors: 1 Department of Onco-Hematology, Portuguese Institute of Oncology, Porto, Portugal.
authors: Márcio
authors: M
authors: Tavares
authors: 2 Department of Anesthesiology, Portuguese Institute of Oncology, Porto, Portugal.
authors: Inês
authors: I
authors: Neves
authors: 1 Department of Onco-Hematology, Portuguese Institute of Oncology, Porto, Portugal.
authors: Sérgio
authors: S
authors: Chacim
authors: 3 Department of Anesthesiology, Intensive Care Unit, Portuguese Institute of Oncology, Porto, Portugal.
authors: Fernando
authors: F
authors: Coelho
authors: 3 Department of Anesthesiology, Intensive Care Unit, Portuguese Institute of Oncology, Porto, Portugal.
authors: Ofélia
authors: O
authors: Afonso
authors: 3 Department of Anesthesiology, Intensive Care Unit, Portuguese Institute of Oncology, Porto, Portugal.
authors: Anabela
authors: A
authors: Martins
authors: 1 Department of Onco-Hematology, Portuguese Institute of Oncology, Porto, Portugal.
authors: J Mário
authors: JM
authors: Mariz
authors: 3 Department of Anesthesiology, Intensive Care Unit, Portuguese Institute of Oncology, Porto, Portugal.
authors: Filomena
authors: F
authors: Faria
mesh_terms: D000368:Aged; D003657:Decision Making; D005060:Europe; D005190:Family / Q000523:psychology; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology / Q000628:therapy*; D009503:Neutropenia; D012189:Retrospective Studies; D013727:Terminal Care / Q000379:methods* / Q000523:psychology; D028761:Withholding Treatment
keywords: cancer; critical care; end-of-life care; hospital mortality; neutropenia