No Exit: Identifying Avoidable Terminal Oncology Intensive Care Unit Hospitalizations

Area of Science:

• Oncology
• Critical Care Medicine
• Palliative Care

Background:

• Terminal oncology intensive care unit (ICU) hospitalizations incur significant costs and are linked to suboptimal care quality.
• Identifying potentially avoidable ICU admissions for terminally ill cancer patients is crucial for improving end-of-life care and resource allocation.

Purpose of the Study:

• To identify and characterize potentially avoidable terminal admissions of oncology patients to the ICU.
• To analyze factors associated with avoidable terminal ICU hospitalizations in cancer patients.

Main Methods:

• Retrospective case series of 72 oncology patients who died in an ICU over a 12-month period at an academic medical center.
• Review of electronic health records by an oncologist, intensivist, and hospitalist to determine avoidability of ICU admission.
• Univariate and multivariate analyses to identify characteristics associated with avoidable terminal ICU hospitalizations.

Main Results:

• 47% of terminal ICU hospitalizations were deemed potentially avoidable.
• Avoidable admissions were associated with poorer pre-admission performance status, higher Charlson comorbidity scores, specific hospitalization reasons, and a greater number of prior hospitalizations.
• Despite high-intensity care, only 25% of patients had documented advance directives, with 81% being intubated and 39% receiving cardiopulmonary resuscitation during their ICU stay.

Conclusions:

• A substantial proportion of terminal ICU hospitalizations for oncology patients are potentially avoidable.
• Healthcare leaders must develop strategies for early identification of high-risk patients and implement interventions to enhance end-of-life care for cancer patients.
• Further research is needed to optimize transitions of care and improve the quality of end-of-life experiences for terminally ill cancer patients.