Risk of Critical Illness Among Patients With Solid Cancers
Authors: Kathryn Puxty, Philip McLoone, Tara Quasim, Billy Sloan, John Kinsella, David S. Morrison
Journal: JAMA Oncology (2015)

urvival from most cancers has improved, but international variations persist, with poorer survival in the United Kingdom than other developed countries.Variations in outcomes manifest soon after diagnosis.For example, socioeconomic variations in survival from colorectal cancers are largely confined to excess mortality in the postoperative period, and international variations in breast cancer survival are most pronounced in the first month and year after diagnosis. 1,2However, it remains unclear what mediates better survival.It has been suggested that quality of health care may explain international variations in cancer outcomes. 3hile this is often considered in terms of availability and effectiveness of therapeutic interventions, the role of support-ive care to prevent or ameliorate critical illness among patients with cancer may also be important.The development of a critical illness requiring support in an intensive care unit (ICU) has received relatively little attention for patients with cancer.ICUs provide enhanced physiological monitoring and support of organ system failure, with higher than normal staff-to-patient ratios and greater costs. 4ICU care is physically and psychologically traumatic and is associated with persisting morbidity after discharge. 5,6The United Kingdom has considerably lower provision of ICU beds, at 3.5 per 100 000 population, than other European countries, North America, and Australasia. 7Among the EUROCARE countries, those with consistently IMPORTANCE Critical illness may be a potential determinant of cancer outcomes and geographic variations, but its role has not been described before.OBJECTIVE To determine the incidence of admission to intensive care units (ICUs) within 2 years following cancer diagnosis. DESIGN, SETTING, AND PARTICIPANTSThis was a retrospective observational study using cancer registry data in 4 datasets from 2000 to 2009 with linked ICU admission data from 2000 to 2011, in the West of Scotland region of the United Kingdom (population, 2.4 million; all 16 ICUs within the region).All 118 541 patients (Ն16 years) diagnosed as having solid (nonhematological) cancers.Their median age was 69 years, and 52.0% were women. MAIN OUTCOMES AND MEASURES Demographic and clinical variables associated with admission to an ICU and death in an ICU.RESULTS A total of 118 541 patients met the study criteria.Overall, 6116 patients (5.2% [95% CI, 5.0%-5.3%])developed a critical illness and were admitted to an ICU within 2 years.Risk of critical illness was highest at ages 60 to 69 years and higher in men.The cumulative incidence of critical illness was greatest for small intestinal (17.2% [95% CI, 13.3%-21.8%])and colorectal cancers (16.5% [95% CI, 15.9%-17.1%]).The risk following breast cancer was low (0.8% [95% CI, 0.7%-1.0%]).The percentage who died in ICUs was 14.1% (95% CI, 13.3%-15.0%),and during the hospital stay, 24.6% (95% CI, 23.5%-25.7%).Mortality was greatest among emergency medical admissions and lowest among elective surgical patients.The risk of critical illness did not vary by socioeconomic circumstances, but mortality was higher among patients from deprived areas.CONCLUSIONS AND RELEVANCE In this study, about 1 in 20 patients experienced a critical illness resulting in ICU admission within 2 years of cancer diagnosis.The associated high mortality rate may make a significant contribution to overall cancer outcomes.