Cancer patients admitted to intensive care unit - a six-year retrospective analysis

Literature about critically ill cancer patients admitted to intensive care units (ICUs) is scarce. The decision to recommend ICU admission is complex and usually involves many subjective factors, making it an intricate issue for both medical oncologists and intensive care physicians. As oncologic and supportive measure treatments improve, a question that becomes increasingly relevant is which patients should be admitted to the ICU, as the natural history of cancer is clearly shifting and newer admission parameters should be established.

We performed a retrospective analysis of all patients with a diagnosed malignancy admitted to our ICU from 2008 to 2014. Data were collected from electronic medical records and analyzed to establish factors associated with outcomes including length of stay, complications, mechanical ventilation requirements, and mortality.

We surveyed a total of 165 consecutive patients, of which 79 (47.9%) were female and 86 (52.1%) were male. Patients with solid tumors (N = 93) were significantly older than those with non-solid tumors (N = 68) (60.12 ± 15.86 vs. 45.43 ± 17.42 years; P < 0.001). The most common reason for ICU admission was respiratory failure (55.76%), followed by septic shock (21.82%). Mechanical ventilation was strongly associated with mortality (P < 0.001), with 98.2% of deaths occurring in ventilated patients. Complications during ICU stay were associated with significantly longer length of stay (P < 0.001), particularly for patients with solid tumors.

Given the high heterogeneity of cancer patients, it is difficult to establish definitive guidelines for ICU admission. Our findings demonstrate that traditional criteria such as age or tumor type alone should not determine ICU admission decisions. Instead, decisions should be based on comprehensive clinical judgment for each individual case. Further studies are warranted to develop evidence-based guidelines for critically ill cancer patients.