Portland Veterans Affairs Medical Center, Portland, OR 97239, USA.
J Clin Oncol. 2012 May 10;30(14):1686-91. doi: 10.1200/JCO.2011.40.0846. Epub 2012 Apr 2.
Lung cancer is the leading cause of cancer-related mortality. Intensive care unit (ICU) use among patients with cancer is increasing, but data regarding ICU outcomes for patients with lung cancer are limited.
We used the Surveillance, Epidemiology, and End Results (SEER) -Medicare registry (1992 to 2007) to conduct a retrospective cohort study of patients with lung cancer who were admitted to an ICU for reasons other than surgical resection of their tumor. We used logistic and Cox regression to evaluate associations of patient characteristics and hospital mortality and 6-month mortality, respectively. We calculated adjusted associations for mechanical ventilation receipt with hospital and 6-month mortality.
Of the 49,373 patients with lung cancer admitted to an ICU for reasons other than surgical resection, 76% of patients survived the hospitalization, and 35% of patients were alive 6 months after discharge. Receipt of mechanical ventilation was associated with increased hospital mortality (adjusted odds ratio, 6.95; 95% CI, 6.89 to 7.01; P < .001), and only 15% of these patients were alive 6 months after discharge. Of all ICU patients with lung cancer, the percentage of patients who survived 6 months from discharge was 36% for patients diagnosed in 1992 and 32% for patients diagnosed in 2005, whereas it was 16% and 11% for patients who received mechanical ventilation, respectively.
Most patients with lung cancer enrolled in Medicare who are admitted to an ICU die within 6 months of admission. To improve patient-centered care, these results should guide shared decision making between patients with lung cancer and their clinicians before an ICU admission.
肺癌是癌症相关死亡的主要原因。在癌症患者中，重症监护病房（ICU）的使用正在增加，但有关肺癌患者 ICU 结局的数据有限。
我们使用监测、流行病学和最终结果（SEER）-医疗保险登记处（1992 年至 2007 年）对因非肿瘤切除术而入住 ICU 的肺癌患者进行回顾性队列研究。我们使用逻辑回归和 Cox 回归分别评估患者特征与医院死亡率和 6 个月死亡率的相关性。我们计算了机械通气与医院和 6 个月死亡率的调整相关性。
在因非肿瘤切除术而入住 ICU 的 49373 例肺癌患者中，76%的患者在住院期间存活，35%的患者在出院后 6 个月存活。接受机械通气与医院死亡率增加相关（调整比值比，6.95；95%置信区间，6.89 至 7.01；P<0.001），只有 15%的患者在出院后 6 个月存活。在所有 ICU 肺癌患者中，出院后 6 个月存活的患者比例为 1992 年诊断的患者为 36%，2005 年诊断的患者为 32%，而接受机械通气的患者分别为 16%和 11%。
在医疗保险登记处登记的入住 ICU 的肺癌患者中，大多数在入院后 6 个月内死亡。为了改善以患者为中心的护理，这些结果应指导肺癌患者及其临床医生在入住 ICU 之前做出共同决策。
