Outcomes following critical illness among cancer patients: A population-based observational study using a matched comparison group.


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Mae-Yen Tan1,Philip McLoone1,Billy Sloan1,Tara Quasim1,Kathryn Puxty1,David Morrison1
1University of Glasgow

Abstract

Background

Cancer patients often encounter critical illness requiring organ support in an intensive care unit (ICU). However, ICU physicians are often hesitant to admit patients diagnosed with cancer due to concerns about survival. Short term outcomes may be favourable among cancer patients. Although, it is not known whether critical illness affects longer-term outcomes.

Method

We compared ICU survivors diagnosed with cancer to individually matched non-ICU cancer patients diagnosed between 2000-2011 with up to 5 years' follow-up. ICU patients must have survived 30 days post-discharge and were matched at a 2:1 ratio by sex, age, ICD-10 codes and conditional survival to the cancer registry. The study encompasses the West of Scotland region of the United Kingdom. ICU patients were further subdivided into patients who did and did not receive organ support.

Results

A total of 10505 of patients met the study criteria (3502 ICU patients and 7003 non-ICU patients). Patient population was 59% male and 41% female and 75% of patients were age 60 and above. Colon cancer was the most common cancer diagnosis making up 35% of the patient population, followed by rectal cancers at 16%.  Overall, 5-year survival was 49% (95% CI 46-51%) among cancer patients who had survived a critical illness but received no organ support, 41% (95% CI 38-43%) for patients who received organ support and 43% (95% CI 43-44%) for those had not experience a critical illness.   

Conclusion

In this study, there appears to be a significant difference in long term survival between cancer patients following a critical illness compared to those who have not. However, the differences seem to vary according to different cancers. Colon cancer patients who experienced a critical illness requiring organ support had poorer long term survival than patients who had not experience a critical illness, however, the converse is true for patients diagnosed with rectal cancer.