1Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
2MIT Critical Data, Massachusetts Institute of Technology, Cambridge, MA, USA
3Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
4Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
5Department of Pathology, Stanford University, Stanford, CA, USA
Copyright © 2019 by the Korean Cancer Association
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Values are presented as mean±standard deviation or number (%). Patients with cancer had higher rates of DNR orders, sepsis, comorbidity scores, similar clinical severity scores, received less invasive treatment and had higher 28-day and 1-year mortality. Patients with solid malignancies were more likely to be elective admissions than patients without cancer.
DNR, do not resuscitate; ICU, intensive care unit; SOFA, Sepsis Related Organ Failure Assessment; APACHE-III, Acute Physiology and Chronic Health Evaluation Score.
28-Day mortality (95% CI) |
1-Year mortality (95% CI) |
|||||
---|---|---|---|---|---|---|
Non-cancer | Solid cancer | Hematologic cancers | Non-cancer | Solid cancer | Hematologic cancers | |
Unadjusted odds of deatha) | Reference | 2.47 (2.30 to 2.66) | 2.29 (2.00 to 2.61) | Reference | 4.41 (4.14 to 4.70) | 3.07 (2.73 to 3.46) |
Adjusted odds of death | Reference | 2.38 (2.15 to 2.63) | 1.80 (1.51 to 2.14) | Reference | 4.02 (3.69 to 4.38) | 2.25 (1.93 to 2.62) |
Annual change in odds of deathb) | –5.5 (–4.1 to –6.9)* | 6.1 (–3.0 to –9.2)* | –10.6 (–4.7 to –16.2)* | –6.2 (–5.1 to –7.3)* | –5.4 (–1.8 to –7.2)* | –8.8 (–3.7 to –17.6)* |
Connective tissue (n=214) | - | NA | - | - | –9.9 (+6.3 to –24.0) | - |
Gastrointestinal (n=1,214) | - | –5.8 (0.0 to –17.6) | - | - | –9.6 (–4.4 to –14.6)* | - |
Genitourinary (n=590) | - | –9.6 (0.0 to –18.6) | - | - | –3.2 (+4.7 to –10.5) | - |
Oral (n=77) | - | NA | - | - | NA | - |
Respiratory and thoracic (n=971) | - | –8.1 (–1.9 to –14.0)* | - | - | –2.5 (+4.2 to –8.7) | - |
Other/unclassified solid (n=1,270) | - | –5.0 (+1.2 to –10.8) | - | - | –3.4 (+2.5 to –9.0) | - |
Leukemia (n=443) | - | - | –13.0 (–3.4 to –21.8)* | - | - | –9.3 (–0.4 to –17.6)* |
Lymphoma (n=527) | - | - | –9.2 (0.0 to –17.8) | - | - | –8.0 (–0.5 to –15.0)* |
Unclassified/other hematologic (n=173) | - | - | NA | - | - | –22.0 (–7.9 to –35.0)* |
Annual change in odds of death for patients with metastatic cancer (n=1,725)c) | - | –7.5 (–2.7 to –12.1)* | - | - | –5.5 (–0.6 to –10.2)* | - |
NA, insufficient data for each stratum to adjust for all confounders.
* p < 0.05.
a) Comparison of the odds of death of patients with solid/hematologic malignancies to patients with no cancer,
b) Adjusted annualized change in the odds of death compared to 2002 by cancer type and anatomic location,
c) Annual change in odds of death for patients with metastatic cancer (compared to 2002). Negative values indicate decreased mortality rates.
Variable | Without cancer | Hematologic malignancy | Solid malignancy | Hematologic and solid cancer |
---|---|---|---|---|
No. of patients | 35,989 | 1,083 | 4,330 | 66 |
Age at admission (yr) | 63.7±17.9 | 65.1±16.3 | 66.3±13.6 | 71.4±13.3 |
Type of admission | ||||
Elective | 4,781 (13.3) | 82 (7.6) | 1,033 (23.9) | 15 (22.7) |
Urgent | 702 (2.0) | 24 (2.2) | 70 (1.6) | 2 (3.0) |
Emergency | 30,506 (84.8) | 977 (90.2) | 3,227 (74.5) | 49 (74.2) |
Sepsis | 9,976 (27.7) | 508 (46.9) | 1,260 (29.1) | 23 (34.8) |
DNR at admission | 1,803 (5.0) | 67 (6.2) | 313 (7.2) | 8 (12.1) |
White race | 25,785 (71.6) | 837 (77.3) | 3,268 (75.5) | 53 (80.3) |
Length of stay ICU (day) | 4.6±6.1 | 5.4±7.2 | 4.1±5.2 | 3.9±3.2 |
Length of stay hospital (day) | 9.3±8.7 | 14.8±15.3 | 10.0±8.2 | 10.1±9.0 |
Use of ventilation | 18,124 (50.4) | 464 (42.8) | 1,888 (43.6) | 28 (42.4) |
Use of vasopressors | 12,310 (34.2) | 365 (33.7) | 1,109 (25.6) | 15 (22.7) |
Elixhauser score | 8.7±11.1 | 17.4±11.7 | 19.1±12.9 | 25.2±12.4 |
SOFA score | 3.3±2.5 | 4.6±3.0 | 3.3±2.6 | 3.8±2.9 |
APACHE-III score | 42.0±19.4 | 50.3±22.2 | 44.4±20.2 | 48.7±21.3 |
28-Day mortality | 4,598 (12.8) | 300 (27.7) | 1,185 (27.4) | 18 (27.3) |
1-Year mortality | 8,284 (23.0) | 570 (52.6) | 2,514 (58.1) | 38 (57.6) |
28-Day mortality (95% CI) |
1-Year mortality (95% CI) |
|||||
---|---|---|---|---|---|---|
Non-cancer | Solid cancer | Hematologic cancers | Non-cancer | Solid cancer | Hematologic cancers | |
Unadjusted odds of death |
Reference | 2.47 (2.30 to 2.66) | 2.29 (2.00 to 2.61) | Reference | 4.41 (4.14 to 4.70) | 3.07 (2.73 to 3.46) |
Adjusted odds of death | Reference | 2.38 (2.15 to 2.63) | 1.80 (1.51 to 2.14) | Reference | 4.02 (3.69 to 4.38) | 2.25 (1.93 to 2.62) |
Annual change in odds of death |
–5.5 (–4.1 to –6.9) |
6.1 (–3.0 to –9.2) |
–10.6 (–4.7 to –16.2) |
–6.2 (–5.1 to –7.3) |
–5.4 (–1.8 to –7.2) |
–8.8 (–3.7 to –17.6) |
Connective tissue (n=214) | - | NA | - | - | –9.9 (+6.3 to –24.0) | - |
Gastrointestinal (n=1,214) | - | –5.8 (0.0 to –17.6) | - | - | –9.6 (–4.4 to –14.6) |
- |
Genitourinary (n=590) | - | –9.6 (0.0 to –18.6) | - | - | –3.2 (+4.7 to –10.5) | - |
Oral (n=77) | - | NA | - | - | NA | - |
Respiratory and thoracic (n=971) | - | –8.1 (–1.9 to –14.0) |
- | - | –2.5 (+4.2 to –8.7) | - |
Other/unclassified solid (n=1,270) | - | –5.0 (+1.2 to –10.8) | - | - | –3.4 (+2.5 to –9.0) | - |
Leukemia (n=443) | - | - | –13.0 (–3.4 to –21.8) |
- | - | –9.3 (–0.4 to –17.6) |
Lymphoma (n=527) | - | - | –9.2 (0.0 to –17.8) | - | - | –8.0 (–0.5 to –15.0) |
Unclassified/other hematologic (n=173) | - | - | NA | - | - | –22.0 (–7.9 to –35.0) |
Annual change in odds of death for patients with metastatic cancer (n=1,725) |
- | –7.5 (–2.7 to –12.1) |
- | - | –5.5 (–0.6 to –10.2) |
- |
Values are presented as mean±standard deviation or number (%). Patients with cancer had higher rates of DNR orders, sepsis, comorbidity scores, similar clinical severity scores, received less invasive treatment and had higher 28-day and 1-year mortality. Patients with solid malignancies were more likely to be elective admissions than patients without cancer. DNR, do not resuscitate; ICU, intensive care unit; SOFA, Sepsis Related Organ Failure Assessment; APACHE-III, Acute Physiology and Chronic Health Evaluation Score.
NA, insufficient data for each stratum to adjust for all confounders. p < 0.05. Comparison of the odds of death of patients with solid/hematologic malignancies to patients with no cancer, Adjusted annualized change in the odds of death compared to 2002 by cancer type and anatomic location, Annual change in odds of death for patients with metastatic cancer (compared to 2002). Negative values indicate decreased mortality rates.