Background: Decisions relating to the appropriateness of admitting critically unwell patients with cancer to an intensive care unit (ICU) can often be complex. This study aimed to evaluate the short and medium term outcomes of critically unwell patients with solid organ malignancies who were admitted to an Australian tertiary hospital ICU following systemic therapy and explored potential prognostic factors.
Methods: We conducted a retrospective study of adults with solid organ malignancies admitted to the ICU at the Royal Brisbane and Women’s Hospital between January 2017 and July 2021.
Results: 202 patients with active cancer and an ICU admission were identified; 132 had received systemic therapy within 3 months of admission date. 64% were planned ICU admissions, 36% were unplanned. Among those with unplanned ICU admissions, ICU and in-hospital mortality was low (2.0% & 14.3% respectively). 28.6% of patients were being treated with curative intent, 71.4% with palliative intent. Survivors of unplanned ICU admission had average APACHE II and III scores of 19.9 and 64.7 at admission, while those who died had higher scores (24.0 and 78.1). Patients receiving curative treatment had numerically higher ICU, in-hospital and longer term survival. Mortality did not significantly differ by tumour type. Neutropenia and number of organ failures did not appear prognostic of ICU survival.
Conclusion: This study suggests that the current patient selection for ICU admission for patients with solid organ malignancies in our centre is appropriate but likely highly selective. We found lower than expected unplanned admissions and higher than expected survival rates compared to other similar studies. These factors limited a planned analysis of potential prognostic factors given the low event rate. Nevertheless, this study supports further research investigating the factors and decisions leading to acceptance of unplanned ICU admissions in our centre.