Does a Diagnosis of Solid Tumor Prohibit Postsurgical ICU Admissions?

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Physicians can be hesitant to admit patients with cancer to the ICU due to fears of poor prognoses.
Physicians can be hesitant to admit patients with cancer to the ICU due to fears of poor prognoses.

Mortality rates are initially lower among surgical patients with cancer who are admitted to the intensive care unit (ICU) compared with patients in the ICU with different conditions, according to a study published in JAMA Surgery.

Many patients with solid malignant tumors undergo surgery, but physicians can be hesitant to admit patients to the ICU due to fears of poor prognoses and death. The outcomes of patients with solid tumors admitted to the ICU have been previously investigated, but due to a lack of a comparator group, the effect of cancer in this setting requires further study. 

For this retrospective, observational study, researchers evaluated the outcomes of 25,017 surgical patients who were admitted to 16 general adult ICUs in the West of Scotland, of which 5462 (21.8%) had a diagnosis of solid tumor. 

ICU patients with cancer had a median age of 68 years compared with 62 years among noncancer patients and a significantly higher proportion of elective hospitalizations. Both groups had comparable health statuses but cancer patients had a lower use of multi-organ support. 

Results showed that patients in the cancer group had a lower ICU mortality rate of 12.2% vs 16.8% among noncancer patients (P<.001), as well as a lower hospital mortality rate with 22.9% vs 28.1% (<.001).

However, these outcomes were short-lived; after 6 months, patients in the cancer group had higher mortality rates compared with patients who did not have cancer (31.3% vs 28.2%; P<.001), and after 4 years, the mortality rate for patients with cancer were 60.9% compared with 39.7% (P<.001).  

The authors concluded, “in view of these findings a diagnosis of cancer should not preclude admission to an ICU in surgical patients. To be able to better inform admission decisions, further work is needed on individual cancers to determine which features have prognostic value.”

Reference

Puxty K, McLoone P, Quasim T, et al. Characteristics and outcomes of surgical patients with solid cancers admitted to the intensive care unit[published online June 27, 2018]. JAMA Oncol. doi:10.1001/jamasurg.2018.1571

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