title: Predictors of the Use of Specific Critical Care Therapies in Patients With Metastatic Cancer.
abstract: Understanding which factors are associated with the use of critical care therapies (CCTs) can help with clinical decision-making and goals of care discussion. The goal of this study was to describe the predictors of CCT use (eg, mechanical ventilation, tracheostomy, percutaneous endoscopic gastrostomy tube, total parenteral nutrition, acute use of dialysis) in hospitalized patients with metastatic cancer.
  
  
  
  We used the 2010 California State Inpatient Databases sponsored by the Agency for Healthcare Research and Quality to identify all hospitalizations with a diagnosis of metastatic cancer (patients aged ≥18 years). We examined the predictors of any CCT use (and invasive mechanical ventilation [IMV] use), stratified by do-not-resuscitate (DNR) status, using multivariable logistic regression models.
  
  
  
  We identified 99,085 hospitalizations involving patients with metastatic cancer; 9.4% received any CCTs and 4.7% received IMV. Predictors of CCT use in the no-DNR group included principal diagnosis of infections (vs cancer-related), greater burden of comorbidities, and presence of weight loss. Predictors of CCT use in the DNR group were similar, but also included non-white races. Liver disease was also a predictor of IMV use in the no-DNR group. Patients with metastatic lung cancer (vs breast and genitourinary) with no DNR were more likely to receive CCT (and IMV).
  
  
  
  Higher burden of comorbidities, weight loss, liver disease, lung cancer subtype, and diagnosis of infections were associated with higher odds of receiving CCTs or IMV. These findings may help clinicians determine in whom to prioritize discussions around goals of care, especially in the group without a DNR status.
authors.affiliation: Division of Hematology/Oncology, James P. Wilmot Cancer Institute, University of Rochester/Strong Memorial Hospital, Rochester, New York
authors.forename: Kah Poh
authors.initials: KP
authors.lastname: Loh
authors.affiliation: Division of Hematology/Oncology, Department of Medicine, Baystate Medical Center, Springfield, Massachusetts
authors.forename: Ankit
authors.initials: A
authors.lastname: Kansagra
authors.affiliation: Department of Medicine, Tufts University School of Medicine, Springfield, Massachusetts
authors.forename: Meng-Shiou
authors.initials: MS
authors.lastname: Shieh
authors.affiliation: Center for Quality of Care Research, Baystate Medical Center, Springfield, Massachusetts|Department of Biostatistics and Epidemiology, University of Massachusetts, Amherst, Massachusetts
authors.forename: Penelope
authors.initials: P
authors.lastname: Pekow
authors.affiliation: Department of Medicine, Tufts University School of Medicine, Springfield, Massachusetts|Center for Quality of Care Research, Baystate Medical Center, Springfield, Massachusetts
authors.forename: Peter
authors.initials: P
authors.lastname: Lindenauer
authors.affiliation: Department of Medicine, Tufts University School of Medicine, Springfield, Massachusetts|Center for Quality of Care Research, Baystate Medical Center, Springfield, Massachusetts
authors.forename: Mihaela
authors.initials: M
authors.lastname: Stefan
authors.affiliation: Department of Medicine, Tufts University School of Medicine, Springfield, Massachusetts|Center for Quality of Care Research, Baystate Medical Center, Springfield, Massachusetts
authors.forename: Tara
authors.initials: T
authors.lastname: Lagu
mesh_terms: D000368:Aged; D002140:California; D000066491:Clinical Decision-Making; D015897:Comorbidity; D003422:Critical Care / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008107:Liver Diseases / Q000150:complications / Q000628:therapy*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000473:pathology / Q000628:therapy*; D012121:Respiration, Artificial / Q000379:methods / Q000706:statistics & numerical data*; D016414:Resuscitation Orders; D012189:Retrospective Studies; D015431:Weight Loss