Long-Term Outcome of Critically Ill Advanced Cancer Patients Managed in an Intermediate Care Unit

Area of Science:

• Oncology
• Critical Care Medicine
• Palliative Care

Background:

• Advanced cancer patients with acute severe complications often require intensive monitoring.
• Intermediate care units (ImCUs) manage patients not critically ill but requiring higher care levels.
• Do not resuscitate (DNR) orders are common in advanced cancer patients, influencing care decisions and outcomes.

Purpose of the Study:

• To analyze the long-term outcomes of advanced cancer patients admitted to an ImCU.
• To specifically investigate the outcomes of patients with DNR orders within the ImCU setting.
• To evaluate the effectiveness of ImCU-centered multidisciplinary management for this patient population.

Main Methods:

• Retrospective observational study (2006-2019) at an academic medical center.
• Inclusion of stage IV cancer patients with acute severe complications admitted to ImCU.
• Utilized Simplified Acute Physiology Score 3 (SAPS 3) for prognostic and severity assessment; calculated in-hospital mortality, 30-day mortality, and post-discharge survival.

Main Results:

• 240 patients included; 47.5% had DNR orders. Sepsis and acute respiratory failure were primary admission reasons.
• Observed in-hospital mortality was 37.5% (standard mortality ratio 0.72), lower than predicted (51.9%).
• Patients with DNR orders had higher observed mortality (52.6% vs. 23.8%) and shorter median survival (46 days vs. 162 days). DNR orders, higher SAPS 3 scores, and worse ECOG status predicted in-hospital mortality. DNR orders, higher bilirubin, and non-invasive ventilation predicted 30-day mortality.

Conclusions:

• ImCU management provides encouraging observed-to-expected mortality ratios for advanced cancer patients with acute complications.
• Multidisciplinary ImCU care benefits even patients with DNR orders, suggesting value in continuous monitoring and management.
• Further research into optimizing ImCU protocols for advanced cancer patients is warranted.