CREDIT (Cancer Related Escalation Decisions for ITU) Study; Survival, functional status and return to anti-cancer therapy in advanced solid tumour patients after emergency admission to critical-care


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Rachel Marshall1, Alec Maynard1, Bilal Tahir2, Hayley Boyce1, Richard Harrold1, Martha Eldridge1, Jessica Johnson1, Danielle Meehan1, Rachel Spiro1, Amanda Swan3, Anna Ratcliffe4, Helena Jennison4, Sarah Kingdon4, Andrew Cruikshanks1, Caroline Wilson1
1Sheffield Teaching Hospitals NHS Foundation Trust, 2University of Sheffield, 3Edinburgh Cancer Centre, 4Derriford Hospital

Abstract

Background

Critical-care (CC) survivorship data for solid tumour patients with incurable disease is based solely on non-UK cancer patients and fails to report quality of life following discharge evidenced by a functional status enabling further anti-cancer therapy (ACT).  Moreover, there are no validated predictive scoring indices for CC survival.   Consequently, UK CC admission criteria for this patient group vary with decisions based on oncologist/intensivist experience. The CREDIT study is a UK multi-centre study aiming to identify independent predictors of CC survival with functional status to enable re-instigation of ACT in UK advanced-cancer patients.  We present data from the first CREDIT enrolled cancer-centre.

Method

Medical records were retrospectively reviewed of all histologically confirmed advanced solid-tumour CC admissions between January 2018- December 2019. Cancer characteristics, co-morbidities, physiological and biochemical variables collected within 24 hours of CC admission were collated. Overall survival (OS) defined as days from date of CC admission to date of death was recorded. If discharged from hospital, Eastern Co-operative Oncology Group performance status (ECOG PS) and return to ACT was evaluated.

Results

36 eligible patient admissions were reviewed. Median age at admission was 64 years. 27 patients were male. Median Charleson co-morbidity index was 8.0. Recent receipt of ACT was common; 44% received cytotoxic therapy, and 39% received targeted/ immuno- therapy within 6 weeks of admission. 17% of admissions were treatment related, 50% were related to disease complications. Median OS was 59 days (range 1-956). However, in those discharged from hospital (61%) median OS was higher (145 days [range 13-956]).  75% of those discharged had an ECOG PS of ≤2 with 22% of patients going on to receive further ACT.

Conclusion

Single centre data from the CREDIT study indicates there is a population of UK advanced-cancer patients who survive CC with maintained ECOG PS enabling re-instigation of ACT.  Further enrolment of UK centres into CREDIT aims to identify common baseline predictive variables at the point of CC admission to better select this population.

Impact statement

These data demonstrate the feasibility of CREDIT in describing CC survivorship of UK advanced cancer patients and show promise that further enrolment of other centres could identify key prognostic variables.