Why Are Patients With Lung Cancer Admitted to ICUs?

Colin R. Cooke, MD, MSc, MS; Assistant Professor of Medicine, Division of Pulmonary & Critical Care Medicine Faculty, Center for Healthcare Outcomes & Policy University of MichiganMedicalResearch.com Interview with:
Colin R. Cooke, MD, MSc, MS;
Assistant Professor of Medicine,
Division of Pulmonary & Critical Care Medicine
Faculty, Center for Healthcare Outcomes & Policy
University of Michigan

MedicalResearch: What are the main findings of the study?

Dr. Cooke: There were three primary findings from our study.

First, we determined that between 1992 and 2005 there was almost a 40% increase in the number of admissions to an intensive care unit (ICU) among patients with lung cancer who were hospitalized for reasons other than surgical removal of their cancer.

Second, most of this increase was because doctors were admitting these patients to intermediate intensive care units. These are units that provide greater monitoring and nurse staffing than typically available in general hospital wards, but usually also have less ability to provide life support measures than full service ICUs.

Third, over the same period the reasons for ICU admission have changed. Although the most common reason for admission continues to be for problems related to the patients’ lung cancer, problems such as breathing difficulties requiring a ventilator and severe infections are increasingly common.

These findings suggest that although overall use of the ICU for patients with lung cancer is increasing over time, providers may be shifting some of the intensive care for lung cancer patients toward less aggressive settings such as the intermediate care unit.

MedicalResearch: Were any of the findings unexpected?

Dr. Cooke: One somewhat unexpected finding was the temporal changes in the type of ICU in which patients received the majority of their care. As discussed above, much of the increase in admission to the ICU was due to admissions to intermediate ICUs. Although we’re unable to determine the most appropriate ICU setting for each lung cancer patient, we know that the 6 month mortality for this group is quite high, prompting some providers to question the appropriateness of admission of such patients to full service ICUs. Our findings suggests that instead of admitting lung cancer patients to full-service ICUs, providers may appreciate the poor prognosis of hospitalized patients with lung cancer and consciously admit them to less aggressive settings.

MedicalResearch: What should clinicians and patients take away from your report?

Dr. Cooke: In light of the high 6 month mortality of lung cancer patients, clinicians and patients should consider goals of care prior to ICU admission. Patients who want and need life support  measures may be better served in a full service ICU.  Patients who opt to forgo aggressive life sustaining measures may still benefit from intermediate ICU care if they have a need for intensive nursing care or non-invasive therapies. Finally, other patients may be best served on a regular hospital floor or hospice unit with involvement of palliative care services.

MedicalResearch: What recommendations do you have for future research as a result of this study?

Dr. Cooke: There are several potential avenues of research that our study motivates.

First, we need a better understanding of why patients with lung cancer are admitted to both intermediate ICUs as well as full-service ICUs, and whether or not the trends we’re observing reflect provider’s understanding of patient treatment preferences.

Second, relatively little is know about how intermediate ICUs are used in the United States generally, which patients end up in such units, and how hospitals are using them as alternative locations for care delivery to an ICU.

Citation:

Aggressiveness of intensive care use among patients with lung cancer in the SEER-Medicare registry

Colin R. Cooke, MD, MSc, MS; Laura C. Feemster, MD, MSc; Renda Soylemez Wiener, MD, MPH; Maya E. O’Neil, PhD; Christopher G. Slatore, MD, MSc

Chest. 2014. doi:10.1378/chest.14-0477

 

 

 

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