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Jose Miguel Montes



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    MA16 - Prioritizing Use of Technology to Improve Survival of Lung Cancer Subgroups and Outcomes with Chemotherapy and Surgery (ID 142)

    • Event: WCLC 2019
    • Type: Mini Oral Session
    • Track: Treatment in the Real World - Support, Survivorship, Systems Research
    • Presentations: 1
    • Now Available
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      MA16.11 - Early and Late Survival Comparison Between Oncological Versus Non-Oncological Patients Admitted to a General Intensive Care Unit in Chile (Now Available) (ID 1948)

      15:45 - 17:15  |  Author(s): Jose Miguel Montes

      • Abstract
      • Presentation
      • Slides

      Background

      Cancer patients are a heterogeneous population and usually admission to ICU units was discouraged due to negative outcomes. In the past years, literature supports the admission at ICU for oncological patients that need invasive mechanical ventilation (IMV) with new admission policy known as the ICU-trial, with aim to recognize a group of patients that may benefit of limited time of intensive support and treatment. The purpose of this trial is to describe the characteristics and overall survival of a prospective cohort of invasive mechanical ventilation (IMV) patients admitted to an ICU of Clinica Alemana.

      Method

      This is an observational, prospective and analytical cohort study conducted in ClĂ­nica Alemana de Santiago. We included patients with cancer > 18 years old, with baseline Eastern Cooperative Oncology Group (ECOG) performance status classification from 0 to 3, who were admitted to ICU and needed IMV between October 2017 and February 2019. Demographic, physiologic, laboratory, clinical and treatment data were extracted prospectively in a database-updated daily. Survival data was obtained from national death registry database.

      Result

      A total of 1,490 patients were admitted between October 2017 and February 2019. A total of 358 patients (24%) had oncological diagnosis and 100 patients were supported with IMV. According to ICU plan, 76 patients were treated as full code and 24 patients as ICU-trial. Among all IMV patients ICU mean of length of stay (LOS) was of 7 days. At the comparison between oncological vs non-oncological patients, APACHE II score and the first-day SOFA score were not statistically different between both groups. Among oncological patients, 73,3% of patients were ECOG 1 and solids tumors were more common than hematological malignancies (90% vs 10%). Lung and digestive cancer were the most frequent malignancies. Full code management was the most frequent strategy at ICU admission in comparison to ICU-trial (76% vs 24%). Survival at day 28 between oncological and non-oncological patients was 76.3% vs 79.3% respectively (p=0.588). However, survival was significantly different at day 90 (64.3% vs 78.8% respectively, p=0.015) and at end of following period (52% vs 76.2% respectively, p<0.001). Remarkably, survival adjusted by cox regression showed a significant lower survival in oncological patients with ECOG 2 and ECOG 3 while the patients with ECOG 0 and 1 had a similar survival to non-oncological patients. According to ICU plan management statistically significant difference was observed in the group of oncological patients with higher survival in full code vs ICU-trial (59.5% vs 29.2% respectively, p=0.015) with a hazard ratio 0.52 [0.28-0.94].

      Conclusion

      Our data suggest that in oncological patients the short-term survival is determined for severity of the critical illness and the late survival is lower respect to non-oncological patients if poor performance status is documented. In patients with cancer admitted under ICU-trial criteria and supported with invasive mechanical ventilation a late survival close to 30% was observed. Similar to previous studies, our study emphasizes that ICU admission should not be limited only on the basis of a patient having a neoplastic disease and different variables should be considered from patient to patient.

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