Intensive Care Unit Outcomes Among Patients With Cancer After Palliative Radiation Therapy

Jacqueline M. Kruser, Sunpreet S. Rakhra, Ryan M. Sacotte, Firas Wehbe, Alfred W Rademaker, Richard G Wunderink, Timothy Joseph Kruser*

*Corresponding author for this work

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Purpose 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. Methods and Materials 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. Results 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. Conclusions 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.

Original languageEnglish (US)
Pages (from-to)854-858
Number of pages5
JournalInternational Journal of Radiation Oncology Biology Physics
Volume99
Issue number4
DOIs
StatePublished - Nov 15 2017

Fingerprint

Palliative Care
Intensive Care Units
radiation therapy
Radiotherapy
cancer
Neoplasms
mortality
Hospital Mortality
Referral and Consultation
adjusting
Patient Care Planning
Hospice Care
Patient Preference
Therapeutics
logistics
Critical Illness
Hospitalization
Cohort Studies
regression analysis
confidence

ASJC Scopus subject areas

  • Radiation
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

Cite this

@article{d8b456fce6ef48bcb1a4adb9774b8bdd,
title = "Intensive Care Unit Outcomes Among Patients With Cancer After Palliative Radiation Therapy",
abstract = "Purpose 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. Methods and Materials 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. Results 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. Conclusions 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.",
author = "Kruser, {Jacqueline M.} and Rakhra, {Sunpreet S.} and Sacotte, {Ryan M.} and Firas Wehbe and Rademaker, {Alfred W} and Wunderink, {Richard G} and Kruser, {Timothy Joseph}",
year = "2017",
month = "11",
day = "15",
doi = "10.1016/j.ijrobp.2017.06.2463",
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Intensive Care Unit Outcomes Among Patients With Cancer After Palliative Radiation Therapy. / Kruser, Jacqueline M.; Rakhra, Sunpreet S.; Sacotte, Ryan M.; Wehbe, Firas; Rademaker, Alfred W; Wunderink, Richard G; Kruser, Timothy Joseph.

In: International Journal of Radiation Oncology Biology Physics, Vol. 99, No. 4, 15.11.2017, p. 854-858.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Intensive Care Unit Outcomes Among Patients With Cancer After Palliative Radiation Therapy

AU - Kruser, Jacqueline M.

AU - Rakhra, Sunpreet S.

AU - Sacotte, Ryan M.

AU - Wehbe, Firas

AU - Rademaker, Alfred W

AU - Wunderink, Richard G

AU - Kruser, Timothy Joseph

PY - 2017/11/15

Y1 - 2017/11/15

N2 - Purpose 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. Methods and Materials 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. Results 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. Conclusions 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.

AB - Purpose 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. Methods and Materials 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. Results 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. Conclusions 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.

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DO - 10.1016/j.ijrobp.2017.06.2463

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