Intensive Care in Patients with Lung Cancer: A Multinational Study
Menée dans six pays d'Europe et d'Amérique du Sud auprès de 449 patients atteints d'un cancer du poumon, cette étude prospective internationale analyse les caractéristiques cliniques et la survie de patients admis dans des unités de soins intensifs
Background : Detailed information about lung cancer patients requiring admission to intensive care units (ICU) is mostly restricted to single center studies. Our aim was to evaluate the clinical characteristics and outcomes of lung cancer patients admitted to ICUs. Patients and Methods : Prospective multicenter study in 449 patients with lung cancer (small-cell, n=55; non-small-cell, n=394) admitted to 22 ICUs in six countries in Europe and South America during 2011. Multivariate Cox proportional hazards frailty models were built to identify characteristics associated with 30-day and 6-month mortality. Results : Most of the patients (71%) had newly diagnosed cancer. Cancer-related complications occurred in 56% of patients; the most common was tumoral airway involvement (26%). Ventilatory support was required in 53% of patients. Overall hospital, 30-day and 6-month mortality rates were 39%, 41% and 55%, respectively. After adjustment for type of admission and early treatment-limitation decisions, determinants of mortality were organ dysfunction severity, poor performance status (PS), recurrent/progressive cancer, and cancer-related complications. Mortality rates were far lower in the patient subset with non-recurrent/progressive cancer and a good PS, even those with sepsis, multiple organ dysfunctions, and need for ventilatory support. Mortality was also lower in high-volume centers. Poor PS predicted failure to receive the initially planned cancer treatment after hospital discharge. Conclusions : ICU admission was associated with meaningful survival in lung cancer patients with good PS and non-recurrent/progressive disease. Conversely, mortality rates were very high in patients not fit for anticancer treatment and poor PS. In this subgroup, palliative care may be the best option.