1 Department of Palliative Care, Centre Hospitalier de Lyon-Sud , Hospices Civils de Lyon, Lyon, France .
2 Palliative Care Unit, L'Hôpital Nord Ouest , Trévoux, France .
J Palliat Med. 2018 May;21(5):689-693. doi: 10.1089/jpm.2017.0415. Epub 2018 Feb 26.
In France, cancer has become the leading cause of death. Intensive care units (ICU) focus on survival, which may not be an appropriate setting to provide palliative care (PC) as needed by cancer patients and families.
To describe the cancer patients who died in the ICU in 2010 in a French academic medical center.
Retrospective study Measurements: We reviewed medical records of all cancer patients who died in the ICU in 2010. The information collected from electronic medical records included patient sociodemographics and clinical characteristics, PC service referral, and the date of first contact with PC.
Among the 536 cancer patients who died in 2010, 42 (8%) died in the ICU. The cancers were hematological (21%), gastrointestinal (21%) and head and neck (21%). One patient had a PC referral versus 45% in the total population (p < 0.001) and the referral was the same day as the death. Eight (19%) patients had chemotherapy during their last month of life and 2 during the ICU hospitalization. Seventy-four per cent of patient admissions to the ICU related directly to malignancy. The mean time between diagnosis of cancer and death was 2.3 years (standard deviation, 4.4).
Our work highlights the need for early PC in the illness trajectory of cancer patients to prevent the transfer of dying patients to the ICU. More studies are needed to understand the decision making leading to such transfers.
在法国，癌症已成为主要死因。重症监护病房（ICU）专注于生存，而这可能不是为癌症患者及其家属提供姑息治疗（PC）的合适场所。
描述 2010 年在法国一所学术医学中心的 ICU 中死亡的癌症患者。
回顾性研究
我们回顾了 2010 年在 ICU 中死亡的所有癌症患者的病历。从电子病历中收集的信息包括患者的社会人口统计学和临床特征、PC 服务转介以及首次接触 PC 的日期。
在 2010 年死亡的 536 例癌症患者中，有 42 例（8%）死于 ICU。癌症类型为血液学（21%）、胃肠道（21%）和头颈部（21%）。1 例患者有 PC 转介，而在总人群中为 45%（p<0.001），转介发生在死亡当天。8 例（19%）患者在生命的最后一个月接受了化疗，2 例在 ICU 住院期间接受了化疗。74%的 ICU 入院与恶性肿瘤直接相关。癌症诊断与死亡之间的平均时间为 2.3 年（标准差 4.4）。
我们的工作强调了在癌症患者的疾病进程中早期提供 PC 的必要性，以防止将临终患者转至 ICU。需要更多的研究来了解导致这种转介的决策。
