Kruser Jacqueline M, Rakhra Sunpreet S, Sacotte Ryan M, Wehbe Firas H, Rademaker Alfred W, Wunderink Richard G, Kruser Tim J
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Department of Radiation Oncology, Northwestern University Feinberg School of Medicine and The Robert H. Lurie Comprehensive Cancer Center, Chicago, Illinois.
Int J Radiat Oncol Biol Phys. 2017 Nov 15;99(4):854-858. doi: 10.1016/j.ijrobp.2017.06.2463. Epub 2017 Jun 28.
To inform goals of care discussions at the time of palliative radiation therapy (RT) consultation, we sought to characterize intensive care unit (ICU) outcomes for patients treated with palliative RT compared to all other patients with metastatic cancer admitted to the ICU.
We conducted a retrospective cohort study of patients with metastatic cancer admitted to an ICU in a tertiary medical center from January 2010 to September 2015. We compared in-hospital mortality between patients who received palliative RT in the 12 months before admission and all other patients with metastatic cancer. We used multivariable logistic regression to evaluate the association between receipt of palliative RT and in-hospital mortality, adjusting for patient characteristics and acute illness severity.
Among 1424 patients with metastatic cancer, 11.3% (n=161) received palliative RT before ICU admission. In-hospital mortality was 36.7% for palliative RT patients, compared with 16.6% for other patients with metastatic cancer (P<.001). Receipt of palliative RT was associated with increased in-hospital mortality (odds ratio 2.08, 95% confidence interval 1.34-3.21, P=.001), after adjusting for patient characteristics and severity of critical illness. Only 34 patients (21.1%) treated with palliative RT received additional cancer-directed treatment after ICU admission.
For patients with metastatic cancer, prior treatment with palliative RT is associated with increased in-hospital mortality after ICU admission. Nearly half of patients previously treated with palliative RT either died during hospitalization or were discharged with hospice care, and few received further cancer-directed therapy. Palliative RT referral may represent an opportunity to discuss end-of-life treatment preferences with patients and families.
为了了解姑息性放射治疗（RT）会诊时的护理目标讨论情况，我们试图对接受姑息性RT治疗的患者与入住重症监护病房（ICU）的所有其他转移性癌症患者的ICU结局进行特征描述。
我们对2010年1月至2015年9月在一家三级医疗中心入住ICU的转移性癌症患者进行了一项回顾性队列研究。我们比较了入院前12个月内接受姑息性RT治疗的患者与所有其他转移性癌症患者的院内死亡率。我们使用多变量逻辑回归来评估接受姑息性RT治疗与院内死亡率之间的关联，并对患者特征和急性疾病严重程度进行了调整。
在1424例转移性癌症患者中，11.3%（n = 161）在入住ICU前接受了姑息性RT治疗。姑息性RT治疗患者的院内死亡率为36.7%，而其他转移性癌症患者为16.6%（P <.001）。在调整患者特征和危重病严重程度后，接受姑息性RT治疗与院内死亡率增加相关（优势比2.08，95%置信区间1.34 - 3.21，P =.001）。接受姑息性RT治疗的患者中，只有34例（21.%)在入住ICU后接受了额外的针对癌症的治疗。
对于转移性癌症患者，之前接受姑息性RT治疗与入住ICU后的院内死亡率增加相关。近一半之前接受姑息性RT治疗的患者要么在住院期间死亡，要么出院时接受临终关怀，很少有人接受进一步的针对癌症的治疗。姑息性RT转诊可能是与患者及其家属讨论临终治疗偏好的一个机会。
