Scripties UMCG - Rijksuniversiteit Groningen
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Quality of Life and ICU admissions for patients with Non-small Cell Lung Cancer

(2018) Tattersall, R.M.

Background: Non-small cell lung cancer (NSCLC) is the most common type of lung cancer and most common solid tumor that requires ICU admission. Most patients with lung cancer who are admitted to the ICU will die within six months. This study aimed to analyze survival and the quality of life for patients with NSCLC who were unexpected admitted to an ICU.
Methods: Data was obtained from the Netherlands Cancer Registry (IKNL) and DLCA for patients diagnosed with NSCLC during January 2009-September 2017 (n=1495). Data for patients with an ICU admission were selected from the local electronic medical records (n=10.065). A dataset was created to gather data based on primary endpoints (survival, performance status (WHO) and Last-score), secondary parameters (basic characteristics and comorbidities (ACE-27)) and therapy factors (ICU characteristics).
Results: Thirty-one patients met the inclusion criteria. Most patients were diagnosed with stage I-II NSCLC (n=23). The most frequent reason for ICU admission were “readmission ICU (post-surgery)” and “respiratory failure”. In this study ten patients (32,3%) had an ICU readmission due to post-surgical complications after an earlier elective ICU admission. There was no statistical significant relation between reason for ICU admission and mortality. Most frequent cancer treatment before ICU was surgery (58,1%). The median ICU stay was 4 days, hospital stay before ICU 3 days and 10 days after ICU discharge. In-hospital mortality after ICU was 70,3% (n=13). Mechanical ventilation, vasoactive agents and antimicrobial agents were the most received treatment during ICU. Mechanical ventilation did not lead to a negative ICU outcome, but use of vasoactive agents tends to a higher mortality rate (p=0.055). Main difference is the death at the ICU for stage III-IV (57,1%) compared to stage I-II (25%). The survival time for stage I-II (IQR 0,8-714,5) tends to be longer compared with stage III-IV (IQR 0-16) and also the time between NSCLC diagnosis and date of death is longer (IQR 84-740 vs. IQR 15-158 (p=0,02)). In both stages, most patients had a moderate or severe comorbidity score and a WHO I performance status. Performance status was often not found in patient files, but this study indicates a progress of documentation during time. Unfortunately, no outcomes of the Last-scores were found in patient files.
Conclusion: Admission of NSCLC patients to the ICU leads to a high in-hospital mortality. In this study, no predictive factors for survival could be found, possibly due to the small study population. Further studies are necessary to assess outcomes such as quality of life after ICU admission for patients with NSCLC. Further studies are necessary to assess outcomes such as quality of life after ICU admission for patients with NSCLC.
Key words: Non-small cell lung cancer, Intensive care unit, survival, Quality of life.

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