Despite recent advances in the care of critically ill patients with cancer, studies show that lung cancer is associated with higher Intensive Care Unit (ICU) mortality than other types of cancer. This systematic review and meta-analysis aim to investigate the ICU outcomes and predictors of mortality in critically ill patients with lung cancer.
Methods
PubMed, OVID MEDLINE, Cochrane and Embase were searched to identify relevant studies. The primary outcome was ICU mortality. The secondary outcomes were hospital mortality and predictors of mortality. Abstracts, case reports and case series were excluded.
Results
Thirty-three studies met inclusion criteria, including 28 cohort studies (n = 4123) and five population-based studies (n = 82,475). The pooled ICU mortality was 46.4% (95% CI 41.0-51.8; n = 16,772). The pooled hospital mortality was 51.9% (95% CI 46.9-56.9; n = 72,215). The pooled long-term mortality (6-12 months) was 73.5%, (95% CI 68.2- 78.2; n = 84,008). Predictors of mortality included the presence of metastatic disease (RR 1.30, 95% CI 1.06-1.59), poor performance status (RR 1.33, 95% CI 1.12-1.57), requirement for mechanical ventilation (RR 2.25, 95% CI 1.58-3.21), requirement for vasopressors (RR 1.95, 95% CI 1.54-2.46), higher APACHE or SAPS score (standardized mean difference 0.63, 95% CI 0.45-0.80), and higher SOFA score (mean difference 1.95, 95% CI 1.21-2.70).
Conclusion
Critically ill patients with lung cancer have reasonable short term but poor long-term outcome. Focused and early goals of care discussions are crucial part of ICU care in this patient population.
KratzerTBBandiPFreedmanND, et al.Lung cancer statistics, 2023. Cancer. 2024;130(8):1330-1348.
2.
SiegelRLGiaquintoANJemalA. Cancer statistics, 2024. CA Cancer J Clin. 2024;74(1):12-49.
3.
HowladerNForjazGMooradianMJ, et al.The effect of advances in lung-cancer treatment on population mortality. N Engl J Med. 2020;383(7):640-649.
4.
PotterALRosensteinALKiangMV, et al.Association of computed tomography screening with lung cancer stage shift and survival in the United States: Quasi-experimental study. Br Med J.2022;376:e069008.
5.
MackJWCroninAKeatingNL, et al.Associations between end-of-life discussion characteristics and care received near death: A prospective cohort study. J Clin Oncol. 2012;30(35):4387-4395.
6.
SharmaGFreemanJZhangDGoodwinJS. Trends in end-of-life ICU use among older adults with advanced lung cancer. Chest. 2008;133(1):72-78.
7.
CookeCRFeemsterLCWienerRSO'NeilMESlatoreCG. Aggressiveness of intensive care use among patients with lung cancer in the surveillance, epidemiology, and end results-medicare registry. Chest. 2014;146(4):916-923.
8.
SoubaniAORuckdeschelJC. The outcome of medical intensive care for lung cancer patients: The case for optimism. J Thorac Oncol. 2011;6(3):633-638.
9.
PageMJMcKenzieJEBossuytPM, et al.The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. Br Med J.2021;372:n71.
10.
R Core Team. R: A Language and Environment for Statistical Computing. R Foundation for Statistical Computing; 2022.
11.
BalduzziSRückerGSchwarzerG. How to perform a meta-analysis with R: A practical tutorial. Evid Based Ment Health.2019;22(4):153-160.
12.
Review Manager 5. (RevMan 5) Version 5.4. The Cochrane Collaboration; 2020.
13.
MantelNHaenszelW. Statistical aspects of the analysis of data from retrospective studies of disease. J Natl Cancer Inst. 1959;22(4):719-748.
14.
WellsGAWellsGSheaB, et al.2014. The Newcastle-Ottawa Scale (NOS) for Assessing the Quality of Nonrandomised Studies in Meta-Analyses.
15.
EwerMSAliMKAttaMSMoriceRCBalakrishnanPV. Outcome of lung cancer patients requiring mechanical ventilation for pulmonary failure. JAMA. 1986;256(24):3364–3366.
16.
HarkawayPGlinesCEichenhornMKvalePChapmanRPopovichJJr. (1986). Small cell carcinoma of the lung in the intensive care unit. Henry Ford Hospital medical journal, 34(4):285–287.
17.
AnisoglouSAsteriouCBarbetakisNKakolyrisSAnastasiadouGPnevmatikosI. Outcome of lung cancer patients admitted to the intensive care unit with acute respiratory failure. Hippokratia. 2013;17(1):60-63.
18.
ChouKTChenCSSuKC, et al.Hospital outcomes for patients with stage III and IV lung cancer admitted to the intensive care unit for sepsis-related acute respiratory failure. J Palliat Med. 2012;15(11):1234-1239.
19.
ManiateJMNavaratnamSCheangMSharmaS. Outcome of lung cancer patients admitted to the intensive care unit. Clin Pulm Med.2007;14(5):281-285.
20.
MüllerAMGazzanaMBSilvaDR. Outcomes for patients with lung cancer admitted to intensive care units. Rev Bras Ter Intensiva.2013;25(1):12-16.
21.
PuxtyKGrantCHMcLooneP, et al.Factors associated with intensive care admission in patients with lung cancer: A population-based observational study of 26, 731 patients. BMC Pulm Med.2020;20(1):36.
22.
LinYCTsaiYHHuangCC, et al.Outcome of lung cancer patients with acute respiratory failure requiring mechanical ventilation. Respir Med. 2004;98(1):43-51.
23.
LiuWZhouDZhangL, et al.Characteristics and outcomes of cancer patients admitted to intensive care units in cancer specialized hospitals in China. J Cancer Res Clin Oncol.2024;150(4):205.
24.
MaJChiSBuettnerB, et al.Early palliative care consultation in the medical ICU: A cluster randomized crossover trial. Crit Care Med. 2019;47(12):1707-1715.
25.
BoussatSEl'riniTDubiezADepierreABaraleFCapellierG. Predictive factors of death in primary lung cancer patients on admission to the intensive care unit. Intensive Care Med.2000;26(12):1811-1816.
26.
SchnipperLESmithTJRaghavanD, et al.American Society of Clinical Oncology identifies five key opportunities to improve care and reduce costs: The top five list for oncology. J Clin Oncol. 2012;30(14):1715-1724.
27.
LeongSSTohCKLimWT, et al.A randomized phase II trial of single-agent gemcitabine, vinorelbine, or docetaxel in patients with advanced non-small cell lung cancer who have poor performance status and/or are elderly. J Thorac Oncol. 2007;2(3):230-236.
28.
BakaSAshcroftLAndersonH, et al.Randomized phase II study of two gemcitabine schedules for patients with impaired performance status (Karnofsky performance status <= 70) and advanced non-small-cell lung cancer. J Clin Oncol. 2005;23(10):2136-2144.
29.
ChatelainESimonMHernuRArgaudLCourM. Factors associated with short- and long-term outcomes in lung cancer patients requiring unplanned invasive mechanical ventilation. Med Intensiva.2024;48(1):37-45.
30.
SlatoreCGCecereLMLeTourneauJL, et al.Intensive care unit outcomes among patients with lung cancer in the surveillance, epidemiology, and end results-medicare registry. J Clin Oncol.2012;30(14):1686-1691.
31.
SoaresMDarmonMSalluhJIF, et al.Prognosis of lung cancer patients with life-threatening complications. Chest. 2007;131(3):840-846.
32.
AbbottRRSetterMChanSChoiK. APACHE II: Prediction of outcome of 451 ICU oncology admissions in a community hospital. Ann Oncol: Official Journal of the European Society for Medical Oncology. 1991;2(8):571-574. https://doi.org/10.1093/oxfordjournals.annonc.a058022
33.
Cárdenas-TuranzasMEnsorJWakefieldC, et al.Cross-validation of a sequential organ failure assessment score-based model to predict mortality in patients with cancer admitted to the intensive care unit. J Crit Care.2012;27(6):673-680. https://doi.org/10.1016/j.jcrc.2012.04.018
34.
SoaresMSalluhJI. Validation of the SAPS 3 admission prognostic model in patients with cancer in need of intensive care. Intensive Care Med.2006;32(11):1839-1844. https://doi.org/10.1007/s00134-006-0374-4
35.
KingahPAlzubaidiNYafawiJZDShehadaEAlshabaniKSoubaniAO. Factors associated with mortality in patients with a solid malignancy admitted to the intensive care unit - A prospective observational study. J Crit Care Med (Targu Mures). 2018;4(4):137-142.
36.
OstermannMFerrando-VivasPGoreCPowerSHarrisonD. Characteristics and outcome of cancer patients admitted to the ICU in England, Wales, and northern Ireland and national trends between 1997 and 2013. Crit Care Med.2017;45(10):1668-1676. https://doi.org/10.1097/CCM.0000000000002589
37.
ZimmermanJEKramerAAKnausWA. Changes in hospital mortality for United States intensive care unit admissions from 1988 to 2012. Crit Care. 2013;17(2):R81.
38.
KaukonenKMBaileyMSuzukiSPilcherDBellomoR. Mortality related to severe sepsis and septic shock among critically ill patients in Australia and New Zealand, 2000–2012. JAMA. 2014;311(13):1308-1316.
39.
ZampieriFGRomanoTGSalluhJIF, et al.Trends in clinical profiles, organ support use and outcomes of patients with cancer requiring unplanned ICU admission: A multicenter cohort study. Intensive Care Med. 2021;47(2):170-179.
40.
VigneronCCharpentierJValadeS, et al.Patterns of ICU admissions and outcomes in patients with solid malignancies over the revolution of cancer treatment. Ann Intensive Care. 2021;11(1):182.
41.
Canton-BulnesMLJimenez-SanchezMAlcantara-CarmonaS, et al.Determinants of mortality in cancer patients with unscheduled admission to the Intensive Care Unit: A prospective multicenter study. Med Intensiva (Engl Ed). 2022;46(12):669-679.
42.
KressJPChristensonJPohlmanASLinkinDRHallJB. Outcomes of critically ill cancer patients in a university hospital setting. Am J Respir Crit Care Med. 1999;160(6):1957-1961.
43.
ChenYFLinJWHoCC, et al.Outcomes of cancer therapy administered to treatment-naïve lung cancer patients in the intensive care unit. J Cancer.2017;8(11):1995-2003.
44.
BarthCSoaresMToffartAC, et al.Characteristics and outcome of patients with newly diagnosed advanced or metastatic lung cancer admitted to intensive care units (ICUs). Ann Intensive Care. 2018;8(1):80.
45.
PrigersonHGBaoYShahMA, et al.Chemotherapy use, performance Status, and quality of life at the End of life. JAMA Oncol. 2015;1(6):778-784.
46.
KiehlMGBeutelGBollB, et al.Consensus statement for cancer patients requiring intensive care support. Ann Hematol. 2018;97(7):1271-1282.
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