title: Outcomes in elderly patients admitted to the intensive care unit with solid tumors.
abstract: BACKGROUND
  As the population ages and cancer therapies improve, there is an increased call for elderly cancer patients to be admitted to the intensive care unit (ICU). This study aimed to assess short-term survival and prognostic factors in critically ill patients with solid tumors aged ≥65 years.
  
  
  METHODS
  We conducted a retrospective study. The primary endpoint was ICU mortality. Resumption of anticancer therapy in patients who survived the ICU stay and 90-day mortality were secondary endpoints. All patients aged ≥65 years admitted to the ICU of Georges Pompidou Hospital (Paris, France) between 2009 and 2014 were eligible.
  
  
  RESULTS
  Of 2327 eligible elderly patients (EP), 262 (75.0 ± 6.7 years) with solid tumors were analyzed. These patients were extremely critically ill (SAPS 2 61.9 ± 22.5), and 60.3% had metastatic disease. Gastrointestinal, lung and genitourinary cancers were the most common types of tumors. Mechanical ventilation was required in 51.5% of patients, inotropes in 48.1% and dialysis in 12.6%. Most patients (66.7%) were admitted for reasons unrelated to cancer, including sepsis (30.5%), acute respiratory failure (28.2%) and neurological problems (8.0%). ICU mortality in patients with cancer was 33.6 versus 32.6% among patients without cancer (p = 0.75). Among the cancer EP, the 90-day mortality was 51.9% (n = 136). In multivariate analysis, increased SAPS 2 score and primary tumor site were associated with 90-day death, whereas previous anticancer therapies and poor performance status were not. Among survivor patients from ICU with anti-tumoral treatment indication, 77 (52.7%) had resumption of anticancer treatment.
  
  
  CONCLUSIONS
  Elderly solid tumor patients admitted to the ICU had a mortality rate similar to EP without cancer. Prognostic factors for 90-day mortality were more related to severity of clinical status at admission than the presence or stage of cancer, suggesting that early admission of EP with cancer to the ICU is appropriate.
authors.affiliation: Gastrointestinal Oncology Department, European Georges Pompidou Hospital, Paris, France. ed.auclin@gmail.com.|Intensive Care Unit, European Georges Pompidou Hospital, Paris, France. ed.auclin@gmail.com.|Oncology Department, European Georges Pompidou Hospital, Paris, France. ed.auclin@gmail.com.|Université Paris Descartes, Paris, France. ed.auclin@gmail.com.
authors.forename: Edouard
authors.initials: E
authors.lastname: Auclin
authors.affiliation: Clinical Research Unit, European Georges Pompidou Hospital, Paris, France.
authors.forename: Anaïs
authors.initials: A
authors.lastname: Charles-Nelson
authors.affiliation: Intensive Care Unit, European Georges Pompidou Hospital, Paris, France.
authors.forename: Baptiste
authors.initials: B
authors.lastname: Abbar
authors.affiliation: Intensive Care Unit, European Georges Pompidou Hospital, Paris, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Guérot
authors.affiliation: Oncology Department, European Georges Pompidou Hospital, Paris, France.|Université Paris Descartes, Paris, France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Oudard
authors.affiliation: Intensive Care Unit, European Georges Pompidou Hospital, Paris, France.|Université Paris Descartes, Paris, France.
authors.forename: Caroline
authors.initials: C
authors.lastname: Hauw-Berlemont
authors.affiliation: Oncology Department, European Georges Pompidou Hospital, Paris, France.|Université Paris Descartes, Paris, France.
authors.forename: Constance
authors.initials: C
authors.lastname: Thibault
authors.affiliation: Intensive Care Unit, European Georges Pompidou Hospital, Paris, France.|Université Paris Descartes, Paris, France.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Monnier
authors.affiliation: Intensive Care Unit, European Georges Pompidou Hospital, Paris, France.|Université Paris Descartes, Paris, France.
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Diehl
authors.affiliation: Université Paris Descartes, Paris, France.|Clinical Research Unit, European Georges Pompidou Hospital, Paris, France.
authors.forename: Sandrine
authors.initials: S
authors.lastname: Katsahian
authors.affiliation: Intensive Care Unit, European Georges Pompidou Hospital, Paris, France.|Université Paris Descartes, Paris, France.
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Fagon
authors.affiliation: Gastrointestinal Oncology Department, European Georges Pompidou Hospital, Paris, France.|Université Paris Descartes, Paris, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Taieb
authors.affiliation: Intensive Care Unit, European Georges Pompidou Hospital, Paris, France.|Université Paris Descartes, Paris, France.
authors.forename: Nadia
authors.initials: N
authors.lastname: Aissaoui
keywords: Cancer; Elderly; Intensive care; Outcome; Survival; Treatment