The Reality of Critical Cancer Patients in a Polyvalent Intensive Care Unit

Maria Teresa Neves; Inês Eiriz; Tiago C Tomás; Francisco Gama; Gabriela Almeida; Filipa B Monteiro; Tomás Lamas; Isabel Simões; Isabel Gaspar; Eduarda Carmo

doi:10.7759/cureus.13581

The Reality of Critical Cancer Patients in a Polyvalent Intensive Care Unit

Cureus. 2021 Feb 26;13(2):e13581. doi: 10.7759/cureus.13581.

Authors

Affiliations

¹ Oncology, Hospital São Francisco Xavier, Centro Hospitalar Lisboa Ocidental, Lisbon, PRT.
² Medical Oncology, Hospital Prof. Doutor Fernando Fonseca, Lisbon, PRT.
³ Cardiology, Hospital Santa Cruz, Centro Hospitalar Lisboa Ocidental, Lisbon, PRT.
⁴ Polyvalent Intensive Care Unit, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, PRT.

Abstract

Background and objective With the increasing incidence of cancer and the rise in the survival rates of cancer patients, more and more oncological candidates are being considered for admission to intensive care units (ICU). Several studies have demonstrated no difference in the outcomes of cancer patients compared to non-cancer patients. Our study aimed to describe and analyze the outcomes related to cancer patients in a polyvalent ICU. Methods We conducted a retrospective study of consecutive oncological patients admitted to a polyvalent ICU (2013-2017). Cox model and receiver operating characteristic (ROC) curve analysis were performed to analyze the results. Results A total of 236 patients were included in the study; the mean age of the patients was 53.5 ± 15.3 years, and 65% of them were male. The main cancer types were those related to the central nervous system (CNS; 31%), as well as gastrointestinal (18%), genitourinary (17%), and hematological (15%). Curative/diagnostic surgeries (49%) and sepsis/septic shock (17%) were the main reasons for admission. The Acute Physiology and Chronic Health Evaluation II (APACHE II) and Simplified Acute Physiology Score II (SAPS II) scores in hematological patients vs. solid tumors were as follows: 30 vs. 20 and 63 vs. 38, respectively (p<0.005). Vasopressors, invasive mechanical ventilation (IMV), and renal replacement therapy (RRT) were used more widely in hematological patients compared to solid-tumor patients. Length of stay was longer in hematological patients vs. solid-tumor patients (12.8 vs. 7 days, p=0.002). The median overall survival in hematological patients was one month and that in solid-tumor patients was 5.8 months (p<0.005). The survival rate at six months was better than described in the existing literature (48 vs. 32.4%). Conclusion Both SAPS II and APACHE II scores were reasonably accurate in predicting mortality, demonstrating their value in cancer patients.

Keywords: hematological patients; intensive care unit stay; oncological patients.