Intensive Care Unit Outcomes Among Patients With Cancer After Palliative Radiation Therapy
| Autor: | Ryan Sacotte, Alfred Rademaker, Richard G. Wunderink, Sunpreet Rakhra, Tim J. Kruser, Firas Wehbe, Jacqueline M. Kruser |
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| Rok vydání: | 2017 |
| Předmět: |
Adult
Male Cancer Research medicine.medical_specialty Referral Palliative Radiation Therapy Organ Dysfunction Scores MEDLINE Logistic regression Article law.invention 03 medical and health sciences 0302 clinical medicine law Neoplasms Odds Ratio Humans Medicine Radiology Nuclear Medicine and imaging Hospital Mortality 030212 general & internal medicine Aged Retrospective Studies Aged 80 and over Terminal Care Radiation business.industry Palliative Care Cancer Retrospective cohort study Odds ratio Middle Aged medicine.disease Intensive care unit Intensive Care Units Hospice Care Logistic Models Treatment Outcome Oncology 030220 oncology & carcinogenesis Emergency medicine Female business |
| Zdroj: | International Journal of Radiation Oncology*Biology*Physics. 99:854-858 |
| ISSN: | 0360-3016 |
| DOI: | 10.1016/j.ijrobp.2017.06.2463 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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