ORIGINAL PAPER
Who should be admitted to the intensive care unit? The outcomeof intensive care unit admission in stage IIIB–IV lung cancerpatients
Yu Jung Kim • Mi-Jung Kim • Young-Jae Cho • Jong Sun Park •
Jin Won Kim • Hyun Chang • Jeong-Ok Lee • Keun-Wook Lee • Jee Hyun Kim •
Ho Il Yoon • Soo-Mee Bang • Jae Ho Lee • Choon-Taek Lee • Jong Seok Lee
Received: 22 December 2013 / Accepted: 15 January 2014 / Published online: 22 January 2014
� Springer Science+Business Media New York 2014
Abstract Critical care for advanced lung cancer patients
is still controversial, and the appropriate method for the
selection of patients who may benefit from intensive care
unit (ICU) care is not clearly defined. We retrospectively
reviewed the medical records of stage IIIB–IV lung cancer
patients admitted to the medical ICU of a university hos-
pital in Korea between 2003 and 2011. Of 95 patients, 64
(67 %) had Eastern Cooperative Oncology Group (ECOG)
performance status (PS) C2, and 79 (84 %) had non-small-
cell lung cancer. In total, 28 patients (30 %) were newly
diagnosed or were receiving first-line treatment, and 22
(23 %) were refractory or bedridden. Mechanical ventila-
tion was required in 85 patients (90 %), and ICU mortality
and hospital mortality were 57 and 78 %, respectively.
According to a multivariate analysis, a PaO2/FiO2 ratio
\150 [odds ratio (OR) = 5.51, 95 % confidence interval
(CI) 2.10–14.48, p = 0.001] was independently associated
with ICU mortality, and an ECOG PS C2 (OR = 9.53,
95 % CI 2.03–44.85, p = 0.004) and a need for vasoactive
agents (OR = 6.94, 95 % CI 1.61–29.84, p = 0.009) were
independently associated with hospital mortality. Refrac-
tory or bedridden patients (n = 22) showed significantly
poorer overall survival (11.0 vs. 29.0 days, p = 0.005).
Among 21 patients who were discharged from the hospital,
11 (52 %) received further chemotherapy. Certain
advanced lung cancer patients may benefit from ICU
management. However, refractory patients and patients
with a poor PS do not seem to benefit from ICU care.
Oncologists should try to discuss palliative care and end-
of-life issues in advance to avoid futile care.
Keywords Advanced lung cancer � Intensive care unit �Outcome � Prognosis
Introduction
Lung cancer is the leading cause of cancer-related mor-
tality in Korea and worldwide [1, 2]. An estimated 20,711
new cases and 15,623 deaths from lung cancer were
identified in Korea in 2010 [1]. In addition to its poor
prognosis, lung cancer is also the most common solid
tumor that requires intensive care unit (ICU) management
[3]. ICU management of cancer patients has long been
controversial due to the uniformly high mortality rates
reported in early studies [4, 5]. However, recent advances
in critical care have improved survival in cancer patients
[3, 6], and the optimistic view that such improvements
might be applied to advanced lung cancer is spreading.
This view is based on small cohort studies that have
reported numerically improved survival rates for advanced
lung cancer patients admitted to the ICU [7–18]. However,
a recent study involving 49,373 patients with lung cancer
admitted to an ICU from the Surveillance, Epidemiology,
Yu Jung Kim and Mi-Jung Kim have contributed equally to this work.
Y. J. Kim � J. W. Kim � H. Chang � J.-O. Lee � K.-W. Lee �J. H. Kim � S.-M. Bang � J. S. Lee (&)
Divisions of Hematology and Medical Oncology, Department of
Internal Medicine, Seoul National University Bundang Hospital,
Seoul National University College of Medicine, 166 Gumi-ro,
Bundang-gu, Songnam-si, Gyeonggi-do 463-707, Republic of
Korea
e-mail: [email protected]
M.-J. Kim
National Cancer Center, Goyang-si, Republic of Korea
Y.-J. Cho � J. S. Park � H. I. Yoon � J. H. Lee � C.-T. Lee
Divisions of Pulmonology, Department of Internal Medicine,
Seoul National University Bundang Hospital, Seoul National
University College of Medicine, Songnam-si, Republic of Korea
123
Med Oncol (2014) 31:847
DOI 10.1007/s12032-014-0847-1
and End Results (SEER)-Medicare registry showed that
most patients die within 6 months of admission and that
ICU outcomes among patients with lung cancer did not
improve for patients diagnosed from 1992 to 2005 [19].
In the mean time, end-of-life ICU use among patients
with advanced lung cancer has been increasing over time
[20, 21]. ICU admission in the last 6 months of life
increased from 17.5 % in 1993 to 24.7 % in 2002 in the
United States according to the SEER-Medicare database
[20]. This finding is contrary to our expectations, because
increased hospice use in North America in the last decade
was expected to be associated with less aggressive cancer
care near the end of life. Furthermore, it has been reported
that patients with lung cancer who received early palliative
care had less aggressive care at the end of life, including
ICU care, but longer survival [22].
In this study, we analyzed the reasons for ICU admission
in advanced lung cancer patients, the clinical outcome, and
the factors related to mortality. We also evaluated how we
can identify patients who may not benefit from ICU care.
Patients and methods
Patients
We retrospectively reviewed the medical records of 95
patients with pathologically confirmed lung cancer who
were admitted to the medical ICU at Seoul National Uni-
versity Bundang Hospital between 2003 and 2011. The
patients had stage IIIB or IV non-small-cell lung cancer or
small-cell lung cancer with extensive disease. The protocol
was approved by the institutional review board of Seoul
National University Bundang Hospital.
Data collection
Demographic data, including age, sex, Eastern Cooperative
Oncology Group (ECOG) performance status (PS), histol-
ogy, stage, previous anticancer treatment, smoking history,
and co morbidities, were collected. Data on the treatments
at the ICU, such as mechanical ventilation (MV), hemod-
ialysis, and the use of a vasoactive agent, were also col-
lected. The Simplified Acute Physiology Score (SAPS) II
and the Acute Physiology and Chronic Health Evaluation
(APACHE) II score were calculated based on electronic
medical records. Organ failure was recorded if the patient
had respiratory failure (the presence of hypoxemia or
hypercapnia, clinical symptoms of respiratory distress, or a
need for MV), renal failure (serum creatinine[1.4 mg/dL,
creatinine clearance \60 mL/min, or a need for hemodi-
alysis), cardiovascular failure (a need for vasoactive
agents, the presence of congestive heart failure, or the
occurrence of ventricular tachycardia or fibrillation), neu-
rologic failure (Glasgow Coma Scale \10 or subjective
criteria, such as confusion, decreased responsiveness, or
coma), or hepatic failure (total bilirubin C2.0 mg/dL).
Sepsis was defined according to the criteria of the Ameri-
can College of Chest Physicians/Society of Critical Care
Medicine [23].
We attempted to categorize the reasons for ICU
admission according to the ‘criteria for ICU admission in
cancer patients’ by Azoulay E et al. [24, 25]. We defined
patients who were beyond third-line chemotherapy without
an objective response as refractory patients. We also
classified the reasons for ICU admission from an oncologic
perspective into four categories, after reviewing the med-
ical records of all patients. The first category was ‘cancer-
related events,’ which included obstructive pneumonia,
respiratory failure due to diffuse lung involvement of
cancer, cardiac tamponade, tumor bleeding, neurologic
events, and metabolic events. The second category was
‘treatment-related events,’ including radiation pneumoni-
tis, chemotherapy-induced lung toxicity, infection with
neutropenia, infection without neutropenia, and other
complications related to the treatment. This category
included patients who experienced events that had clear
relationship with the treatment. The third category was
‘infection, not clearly related to cancer or treatment,’
including pneumonia and other infection. Patients in this
category were those who did not receive chemotherapy
within 4 weeks, and those who did not have evidence of
disease progression. The last category was ‘Underlying
comorbidity-related events,’ including pulmonary disease
and cardiovascular disease.
Statistical analysis
Statistical analyses of categorical variables were performed
using Pearson’s v2 test or Fisher’s exact test. Continuous
variables were reported as the mean ± SD. Comparisons
of means between groups were performed using Student’s
t test. The median survival was calculated using the Kap-
lan–Meier method. Comparisons between different groups
were made using log-rank tests. A multivariate logistic
regression analysis was performed to identify independent
factors related to ICU or hospital mortality. Age, sex, and
variables with a p value \0.1 by univariate analysis were
included in the multivariate analysis. The multivariate
analysis was performed using the Cox proportional hazard
model to identify independent factors related to 90-day
mortality. In the case of collinear variables, only one var-
iable was chosen for the multivariate analysis. Two-sided
p values\0.05 were considered significant, and confidence
intervals (CIs) were calculated at a 95 % confidence level.
All statistical analyses were performed with IBM SPSS
847 Page 2 of 7 Med Oncol (2014) 31:847
123
Statistics for Windows, version 21.0 (IBM Corp., Armonk,
NY, USA).
Results
Patient characteristics
The mean age of the 95 patients was 65.6 years. Of these
patients, 17 (18 %) were female, and 64 (67 %) had an
ECOG PS C2. In total, 79 patients (84 %) had non-small-
cell lung cancer, and all patients were stage IV, except for
8 patients (8 %) with stage IIIB disease. Underlying
comorbidity was present in 63 patients (66 %), and 74
(80 %) were smokers. Before ICU admission, 89 patients
(94 %) had received radiotherapy or chemotherapy for
advanced lung cancer, and 80 (84 %) had received pallia-
tive chemotherapy, with a median of two treatment lines
(range 1–6). The median time interval from lung cancer
diagnosis to ICU admission was 198.0 days (range
3–1,512). Additionally, the median duration of the hospital
stay before admitting to the ICU was 4.0 days (range
0–57). Baseline patient characteristics are summarized in
Table 1.
Management at the ICU
The median duration of the ICU stay was 7.0 days (range
0–84). In total, 85 patients (90 %) required MV, 73 (77 %)
required vasoactive agents, and 13 (14 %) required he-
modialysis. Cardiopulmonary resuscitation (CPR) on
admission to the ICU was performed in 14 patients (15 %),
and the mean number of organ failures was 1.6 ± 1.0. On
the first day of ICU admission, the mean SAPS II score was
56.4 ± 18.0, and the mean APACHE II score was
24.1 ± 8.1. Patients’ status at the time of ICU admission
according to ICU survival is summarized in Table 2.
Reasons for ICU admission
According to the ‘criteria for ICU admission in cancer
patients’ by Azoulay E et al. [24, 25], 28 patients (30 %)
were newly diagnosed or were undergoing first-line che-
motherapy, 45 (47 %) were in an intermediate situation,
and 22 (23 %) were refractory or bedridden (Table 3). All
of the refractory or bedridden patients were ‘full code’ at
ICU admission, and none had discussed end-of-life issues,
including their ‘do not resuscitate (DNR)’ preferences,
with their oncologists prior to the event requiring ICU care.
The patients were divided into four groups according to
the reasons for ICU admission from an oncologic per-
spective (Table 3). In total, 28 patients (30 %) had expe-
rienced a cancer-related event, which included obstructive
pneumonia (n = 6), respiratory failure due to diffuse lung
involvement of cancer (n = 7), cardiac tamponade
(n = 4), tumor bleeding (n = 3), neurologic events
(n = 5), and metabolic events (n = 3). Treatment-related
events had developed in 43 patients (45 %) and included
radiation pneumonitis (n = 2), chemotherapy-induced lung
toxicity (n = 3), infection with neutropenia (n = 19),
infection without neutropenia (n = 14), and other com-
plications related to treatment (n = 5). The causes of
infection with or without neutropenia (n = 33) were
pneumonia in all patients, except for two who had neu-
tropenic septic shock without evidence of pneumonia.
Twenty patients (21 %) had infections that were not clearly
Table 1 Baseline characteristics
Variables All patients
(n = 95)
Age, mean 65.6 ± 10.3
Sex
Male 78 (82 %)
Female 17 (18 %)
ECOG PS
0–1 31 (33 %)
2–4 64 (67 %)
Histology
NSCLC 79 (84 %)
Adenocarcinoma 33
Squamous cell carcinoma 22
LCNEC 6
Poorly differentiated carcinoma 9
Other 10
SCLC 15 (16 %)
Stage
IIIB 8 (8 %)
IV 72 (76 %)
ED 15 (16 %)
Smoking history 74 (80 %)
Comorbidity
Cardiovascular disease
(excluding hypertension)
14 (15 %)
Pulmonary disease 41 (43 %)
Diabetes 25 (26 %)
Other 15 (16 %)
Previous treatment
Palliative chemotherapy 80 (84 %)
Palliative radiotherapy 31 (33 %)
Concurrent chemoradiation 11 (12 %)
ECOG Eastern Cooperative Oncology Group, ED extensive disease,
LCNEC large-cell neuroendocrine carcinoma, n number, NSCLC non-
small-cell lung cancer, PS performance status, SCLC small-cell lung
cancer
Med Oncol (2014) 31:847 Page 3 of 7 847
123
related to cancer or treatment, and pneumonia was the
cause of infection in 19 patients (95 %). Underlying
comorbidity-related events included pulmonary disease
(n = 2), and cardiovascular disease (n = 2).
As a whole, 83 patients (87 %) had acute respiratory
failure, and pneumonia was the most common cause of
respiratory failure (64/83 patients, 77 %). Additionally, 26
patients (27 %) had sepsis.
Outcome analysis
With a median follow-up of 20 days (range 0–396) after
ICU admission, the median overall survival was 22 days
Table 2 Patients’ status at the time of ICU admission
Variables All patients (n = 95) ICU survivors (n = 41) ICU non-survivors (n = 54) p
Uncontrolled cancer/PD 41 (43 %) 20 21 0.335
Refractory disease/bedridden 22 (23 %) 7 15 0.221
Number of organ failures 1.6 ± 1.0 1.4 ± 0.9 1.7 ± 1.0 0.114
Acute respiratory failure 83 (87 %) 31 52 0.003
Pneumonia 64 (67 %) 22 42 0.013
Sepsis 26 (27 %) 9 17 0.302
SAPS II 56.4 ± 18.0 51.8 ± 16.1 59.9 ± 18.6 0.025
APACHE II 24.1 ± 8.1 22.5 ± 7.7 25.3 ± 8.2 0.092
Mechanical ventilation 85 (90 %) 32 53 0.002
Vasoactive agent 73 (77 %) 26 47 0.007
CPR 14 (15 %) 6 8 0.980
Hemodialysis 13 (14 %) 3 10 0.094
PaO2/FiO2 179.1 ± 106.8 235.4 ± 121.8 137.4 ± 70.3 <0.001
Decreased mentality 32 (34 %) 15 17 0.602
Bold values indicate statistically significant (p value \ 0.05)
APACHE II acute physiology and chronic health evaluation II, CPR cardiopulmonary resuscitation, FiO2 fraction of inspired oxygen, ICU
intensive care unit, n number, PaO2 partial pressure of O2 in arterial blood, PD progressive disease, SAPS II simplified acute physiology score II,
SCLC small-cell lung cancer
Table 3 Reasons for ICU admission
Number of
patients
ICU
mortality
(%)
Hospital
mortality
(%)
According to the criteria for ICU admission of cancer patients
Newly diagnosed/first-
line treatment (full-
code management)
28/95 (30 %) 54 71
Intermediate situation
(propose an ICU trial)
45/95 (47 %) 53 76
Refractory disease/
bedridden (do not
recommend ICU)
22/95 (23 %) 68 91
Oncologic perspective
Cancer-related events 28/95 (30 %) 57 79
Treatment-related
events
43/95 (45 %) 61 74
Infection, not clearly
related to cancer or
treatment
20/95 (21 %) 60 85
Underlying
comorbidity-related
events
4/95 (4 %) 25 75
ICU intensive care unit
Table 4 Multivariate logistic regression analysis of factors associ-
ated with ICU mortality and hospital mortality
Reference group OR 95 % CI p
ICU mortality
Male 1.17 0.34–3.98 0.801
Age \75 years 2.28 0.55–9.41 0.255
PaO2/FiO2 C150 5.51 2.10–14.48 0.001
No vasoactive agent 2.68 0.87–8.30 0.087
No hemodialysis 1.69 0.37–7.68 0.494
Hospital mortality
Male 0.16 0.02–1.07 0.058
Age \75 years 6.71 0.39–114.80 0.189
ECOG PS 0–1 9.53 2.03–44.85 0.004
No radiotherapy 1.45 0.33–6.38 0.624
No pulmonary disease 0.22 0.04–1.07 0.061
No diabetes 4.64 0.83–26.01 0.081
PaO2/FiO2 C150 2.53 0.60–10.68 0.205
No vasoactive agent 6.94 1.61–29.84 0.009
Bold values indicate statistically significant (p value \ 0.05)
CI confidence interval, ECOG Eastern Cooperative Oncology Group,
FiO2 fraction of inspired oxygen, ICU intensive care unit, OR odds ratio,
PaO2 partial pressure of O2 in arterial blood, PS performance status
847 Page 4 of 7 Med Oncol (2014) 31:847
123
(95 % CI 10.86–33.14). Thirteen patients (14 %) died
within 24 h after being admitted to the ICU. Overall, ICU
mortality was 57 %, and hospital mortality was 78 %. In
the multivariate logistic regression analysis, a PaO2/FiO2
ratio \150 [odds ratio (OR) = 5.51, 95 % CI 2.10–14.48,
p = 0.001] was independently associated with ICU mor-
tality, and an ECOG PS C2 (OR = 9.53, 95 % CI
2.03–44.85, p = 0.004) and a need for vasoactive agents
(OR = 6.94, 95 % CI 1.61–29.84, p = 0.009) were inde-
pendently associated with hospital mortality (Table 4).
The 3-month and 6-month mortality rates were 80 and
87 %, respectively. In the univariate analysis of factors
associated with 90-day mortality, an ECOG PS C2,
refractory disease, number of organ failures C3, a low
PaO2/FiO2 ratio, and a need for vasoactive agents were
statistically significant. In the multivariate analysis, an
ECOG PS C2 [hazard ratio (HR) = 2.21, 95 % CI
1.29–3.80, p = 0.004), refractory disease (HR = 2.18,
95 % CI 1.23–3.89, p = 0.008), and a PaO2/FiO2 ratio
\150 (HR = 1.97, 95 % CI 1.21–3.20, p = 0.006) were
independently associated with 90-day mortality (Table 5).
Refractory or bedridden patients (n = 22) showed signifi-
cantly poorer overall survival (11.0 vs. 29.0 days,
p = 0.005), and only two of these patients were discharged
from the hospital (Fig. 1).
Among 41 patients who were discharged from the ICU,
20 patients died before hospital discharge. Overall, the
median survival following ICU discharge was 56 days
(95 % CI 17.11–94.90; range 2–397). For the 21 patients
who were discharged from the hospital, the median sur-
vival following ICU discharge was 177 days (95 % CI
36.44–317.56; range 18–397). Eleven patients (11/21,
52 %) underwent further systemic chemotherapy after ICU
discharge, and these patients exhibited prolonged survival
after ICU discharge (253 vs. 93 days, p = 0.040).
Discussion
Although the management of critically ill cancer patients has
significantly improved, whether such management could be
applied to advanced lung cancer patients is still unclear.
Several studies have reported encouraging results regarding
ICU care for advanced lung cancer patients, with ICU mor-
tality rates ranging from 31 to 85 % and hospital mortality
rates ranging from 33 to 91 % [7–17] (Table 6). In our study,
the ICU mortality rate was 57 %, and the hospital mortality
rate was 78 %. These values may seem higher than the rates
reported in recent studies, but in our study, all patients had
stage IIIB or IV disease (stage IV, 92 %), and 90 % of the
patients received MV. The proportion of stage IV patients in
the above-mentioned studies was generally 40–60 %, and
the proportion of patients who received MV was as low as
14 %. We analyzed this highly selective patient group in an
attempt to strictly focus on advanced-stage lung cancer
patients receiving ICU care, who may often drive oncologists
and intensivists into difficult and agonizing clinical situa-
tions. Furthermore, because more than 40 % of patients are
stage IV at initial diagnosis, and given that the 5-year sur-
vival rate of lung cancer across all stages is only 15–20 %,
most patients with lung cancer may become candidates for
ICU care at an advanced stage [1, 26].
Azoulay E et al. [24, 25] have suggested criteria for the
recommendation of ICU care for cancer patients, and we
tried to classify our patients according to these criteria. The
authors recommended that newly diagnosed cancer patients
or patients receiving first-line treatment receive full-code
management but did not recommend ICU care for
Table 5 Multivariate analysis of factors associated with 90-day
mortality
Reference group Multivariate p
HR (95 % CI)
Male 0.88 (0.46–1.69) 0.701
Age \75 years 1.11 (0.59–2.11) 0.746
ECOG PS 0–1 2.21 (1.29–3.80) 0.004
Non-refractory 2.18 (1.23–3.89) 0.008
PaO2/FiO2 C150 1.97 (1.21–3.20) 0.006
No vasoactive agent 1.82 (1.00–3.34) 0.052
Bold values indicate statistically significant (p value \ 0.05)
CI confidence interval, ECOG Eastern Cooperative Oncology Group,
FiO2 fraction of inspired oxygen, HR hazard ratio, PaO2 partial
pressure of O2 in arterial blood, PS performance status
Fig. 1 Survival in refractory or bedridden patients
Med Oncol (2014) 31:847 Page 5 of 7 847
123
bedridden patients or patients with no further lifespan-
extending treatment. Finally, the authors recommended
proposing an ICU trial in patients with other situations or
situations in doubts. In our study, 30 % of the patients were
newly diagnosed or receiving first-line treatment, and 23 %
of the patients were refractory or bedridden. Although not
statistically significant, the refractory/bedridden patients
showed higher mortality rates (ICU mortality of 68 % and
hospital mortality of 91 %). These patients also showed
significantly poorer overall survival (11.0 vs. 29.0 days,
p = 0.005), and only two of these patients were discharged
from the hospital. Because there were no established cri-
teria for ICU management, a considerable number of
refractory/bedridden lung cancer patients chose ICU care
in our study. Notably, all of the patients (n = 22) were ‘full
code’ at ICU admission, and none had discussed about end-
of-life issues with their oncologists prior to the event
requiring ICU care. Half of these patients were receiving
‘late-line’ chemotherapy and were admitted to the ICU due
to a chemotherapy-related complication. The patients and
their families could not discuss ICU care sufficiently even
immediately before ICU admission due to the acute dete-
rioration of the patients’ condition. These patients might
not have chosen late-line chemotherapy or ICU care if they
had received early palliative care and had an opportunity to
discuss end-of-life issues in advance [22]. In one recent
study, the ICU admission rate of terminal cancer patients
decreased from 17 to 0 %, following the opening of a
dedicated palliative care unit [27]. Although it would be
ethically unacceptable to limit ICU admission, it might be
even more unethical not to provide a patient with the
opportunity to avoid non-beneficial treatment.
Predictors of poor outcome in previous studies included
a need for MV [7, 9, 10, 12, 13, 16, 28], cancer recurrence
or progression [10, 11, 13, 14, 28–30], a poor PS [8, 13, 14,
27, 30], the number of organ system failures [11, 12, 14],
and a need for vasoactive agents [12, 16]. Concordant with
previous studies, in our study, an ECOG PS C2
(OR = 9.53, 95 % CI 2.03–44.85, p = 0.004) and a need
for vasoactive agents (OR = 6.94, 95 % CI 1.61–29.84,
p = 0.009) were independently associated with hospital
mortality, and an ECOG PS C2 (HR = 2.21, 95 % CI
1.29–3.80, p = 0.004) and refractory disease (HR = 2.18,
95 % CI 1.23–3.89, p = 0.008) were associated with
90-day mortality. In fact, all of our patients can be included
in the category of ‘cancer recurrence or progression,’ but
among these patients, particularly those with refractory
disease showed a poorer prognosis. In addition, as all of the
patients were in an advanced stage of disease, and given
that 90 % of the patients received MV, disease stage and a
need for MV were not predictors of mortality in our study.
However, a PaO2/FiO2 ratio \150 was a significant pre-
dictor of ICU and 90-day mortality. A PaO2/FiO2 ratio
\150 is known to portend high mortality, regardless of the
cause of respiratory failure, and is a significant predictor of
a poor outcome in patients receiving MV for more than
24 h [30]. The results of the multivariate analysis in this
study support the potential futility of ICU care for
advanced cancer patients with refractory disease or a poor
PS.
In conclusion, the clinical outcome of ICU care for
advanced lung cancer patients was poor, particularly in
patients with refractory disease or a poor PS. To avoid non-
beneficial care, oncologists should try to discuss palliative
care and end-of-life issues early in the course of treatment.
Conflict of interest The authors have declared no conflict of
interest.
Table 6 Published literatures on ICU care for advanced lung cancer patients
Study Number of patients NSCLC (%) Stage IV (%) MV (%) ICU mortality (%) Hospital mortality (%)
Ewer et al. [7] 46 65 NR 100 85 91
Boussat et al. [8] 57 92 47 91 67 75
Lin et al. [9] 81 77 59 100 73 85
Reichner et al. [10] 47 83 53 49 43 60
Soares et al. [11] 143 83 NR (IIIB or IV 59 %) 70 42 59
Adam et al. [12] 139 69 40 49 22 40
Roques et al. [13] 105 83 NR (IIIB or IV 66 %) 41 43 54
Toffart et al. [14] 103 80 61 40 31 48
Bonomi et al. [15] 1,134 100 55 14 NR 33
Andrejak et al. [16] 76 65 59 75 47 65
Chou et al. [17] 70 NR NR (IIIB or IV 96 %) 100 NR 59
Current study 95 84 92 (IIIB or IV 100 %) 90 57 78
ICU intensive care unit, MV mechanical ventilation, NR not reported, NSCLC non-small-cell lung cancer
847 Page 6 of 7 Med Oncol (2014) 31:847
123
References
1. Jung KW, Won YJ, Kong HJ, Oh CM, Seo HG, Lee JS. Cancer
statistics in Korea: incidence, mortality, survival and prevalence
in 2010. Cancer Res Treat. 2013;45(1):1–14.
2. Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D.
Global cancer statistics. CA Cancer J Clin. 2011;61(2):69–90.
3. Kress JP, Christenson J, Pohlman AS, Linkin DR, Hall JB.
Outcome of critically ill patients in a university hospital setting.
Am J Respir Crit Care Med. 1999;160(6):1957–61.
4. Carlon GC. Admitting cancer patients to the intensive care unit.
Crit Care Clin. 1988;4:183–91.
5. Schuster DP. Everything that should be done: not everything that
can be done. Am Rev Respir Dis. 1992;145:508–9.
6. Pene F, Percheron S, Lemiale V, Viallon V, Claessens YE,
Marque S, Charpentier J, Angus DC, Cariou A, Chiche JD, Mira
JP. Temporal changes in management and outcome of septic
shock in patients with malignancies in the intensive care unit. Crit
Care Med. 2008;36:690–6.
7. Ewer MS, Ali MK, Atta MS, Morice RC, Balakrishnan PV.
Outcome of lung cancer patients requiring mechanical ventilation
for pulmonary failure. JAMA. 1986;256(24):3364–6.
8. Boussat S, El’rini T, Dubiez A, Depierre A, Barale F, Capellier
G. Predictive factors of death in primary lung cancer patients on
admission to the intensive care unit. Intensive Care Med. 2000;
26:1811–6.
9. Lin YC, Tsai YH, Huang CC, Hsu KH, Wang SW, Tsao TC, Lin
MC. Outcome of lung cancer patients with acute respiratory
failure requiring mechanical ventilation. Respir Med. 2004;98(1):
43–51.
10. Reichner CA, Thompson JA, O’Brien S, Kuru T, Anderson ED.
Outcome and code status of lung cancer patients admitted to the
medical ICU. Chest. 2006;130:719–23.
11. Soares M, Darmon M, Salluh JI, Ferreira CG, Thiery G, Schlemmer
B, Spector N, Azoulay E. Prognosis of lung cancer patients with life-
threatening complications. Chest. 2007;131:840–6.
12. Adam AK, Soubani AO. Outcome and prognostic factors of lung
cancer patients admitted to the medical intensive care unit. Eur
Respir J. 2008;31:47–53.
13. Roques S, Parrot A, Lavole A, Ancel PY, Gounant V, Djibre M,
Fartoukh M. Six-month prognosis of patients with lung cancer
admitted to the intensive care unit. Intensive Care Med. 2009;
35:2044–50.
14. Toffart AC, Minet C, Raynard B, Schwebel C, Hamidfar-Roy R,
Diab S, Quetant S, Moro-Sibilot D, Azoulay E, Timsit JF. Use of
intensive care in patients with nonresectable lung cancer. Chest.
2011;139(1):101–8.
15. Bonomi MR, Smith CB, Mhango G, Wisnivesky JP. Outcomes of
elderly patients with stage IIIB–IV non-small cell lung cancer
admitted to the intensive care unit. Lung Cancer. 2012;77:600–4.
16. Andrejak C, Terzi N, Thielen S, Bergot E, Zalcman G, Char-
bonneau P, Jounieaux V. Admission of advanced lung cancer
patients to intensive care unit: a retrospective study of 76
patients. BMC Cancer. 2011;11:159.
17. Chou KT, Chen CS, Su KC, Hung MH, Hsiao YH, Tseng CM,
Chen YM, Lee YC, Perng DW. Hospital outcomes for patients
with stage III and IV lung cancer admitted to the intensive care
unit for sepsis-related acute respiratory failure. J Palliat Med.
2012;15(11):1234–9.
18. Soubani AO, Ruckdeschel JC. The outcome of medical intensive
care for lung cancer patients: the case for optimism. J Thorac
Oncol. 2011;6:633–8.
19. Slatore CG, Cecere LM, Letourneau JL, O’Neil ME, Duckart JP,
Wiener RS, Farjah F, Cooke CR. Intensive care unit outcomes
among patients with lung cancer in the surveillance, epidemiology,
and end results-medicare registry. J Clin Oncol. 2012;30(14):
1686–91.
20. Sharma G, Freeman J, Zhang D, Goodwin JS. Trends in end-of-
life ICU use among older adults with advanced lung cancer.
Chest. 2008;133:72–8.
21. Ho TH, Barbera L, Saskin R, Lu H, Neville BA, Earle CC.
Trends in aggressiveness of end-of-life cancer care in the uni-
versal health care system of Ontario Canada. J Clin Oncol. 2011;
29(12):1587–91.
22. Temel JS, Greer JA, Muzikansky A, Gallagher ER, Admane S,
Jackson VA, Dahlin CM, Blinderman CD, Jacobsen J, Pirl WF,
Billings JA, Lynch TJ. Early palliative care for patients with
metastatic non-small-cell lung cancer. N Engl J Med. 2010;
363(8):733–42.
23. Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus
WA, Schein RM, Sibbald WJ. Definitions for sepsis and organ
failure and guidelines for the use of innovative therapies in sepsis.
Chest. 1992;101(6):1644–55.
24. Azoulay E, Afessa B. The intensive care support of patients with
malignancy: do everything that can be done. Intensive Care Med.
2006;32:3–5.
25. Darmon M, Azoulay E. Critical care management of cancer
patients: cause for optimism and need for objectivity. Curr Opin
Oncol. 2009;21:318–26.
26. Little AG, Gay EG, Gaspar LE, Stewart AK. National survey of
non-small cell lung cancer in the United States: epidemiology,
pathology and patterns of care. Lung Cancer. 2007;57:253–60.
27. Lim T, Nam SH, Kim MS, Yoon KS, Kim BS. Comparison of
medical expenditure according to types of hospice care in patients
with terminal cancer. Am J Hosp Palliat Care. 2013;30(1):50–2.
28. Soares M, Caruso P, Silva E, Teles JM, Lobo SM, Friedman G,
Dal-Pizzol F, Mello PV, Bozza FA, Silva UV, Torelly AP, Knibel
MF, Rezende E, Netto JJ, Piras C, Castro A, Ferreira BS, Rea-
Neto A, Olmedo PB, Salluh JI, Brazilian Research in Intensive
Care Network (BRICNet). Characteristics and outcomes of
patients with cancer requiring admission to intensive care units: a
prospective multicenter study. Crit Care Med. 2010;38(1):9–15.
29. Mendoza V, Lee A, Marik PE. The hospital-survival and prog-
nostic factors of patients with solid tumors admitted to an ICU.
Am J Hosp Palliat Care. 2008;25:240–3.
30. Soares M, Salluh JI, Spector N, Rocco JR. Characteristics and
outcomes of cancer patients requiring mechanical ventilatory
support for [24 h. Crit Care Med. 2005;33(3):520–6.
Med Oncol (2014) 31:847 Page 7 of 7 847
123