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Outcomes and prognostic factors in patients with head and neck cancer and severe acute illnesses

Márcio Soares| Jorge I. F. Salluh| Luisa Toscano| Fernando L. Dias
Brief Report
Volume 33, Issue 11 / November , 2007

Pages 2009 - 2013

Abstract

Objectives

To evaluate the outcomes of patients with head and neck cancer and severe acute illnesses, and to identify characteristics associated with hospital mortality.

Design

Cohort study.

Setting

Ten-bed medical–surgical oncologic intensive care unit (ICU).

Patients

Consecutive patients admitted to the ICU over a 68-month period.

Interventions

None.

Measurements and results

Demographic, clinical and cancer-related data were collected. Multivariate logistic regression analysis was performed to identify predictive factors of hospital mortality. One hundred and twenty-one patients aged 63.3 ± 14.7 years were enrolled in the study. The main sites of primary tumor were oral cavity (30%), larynx (25%), pharynx (14%) and thyroid (9%). The main reasons for ICU admission were sepsis (37%) and acute respiratory failure (20%). The mean SAPS II score was 49.6 ± 17.8 points, and during ICU stay 100 (83%) patients received mechanical ventilation, 70 (58%), vasopressors, and 12 (10%), dialysis. The ICU, hospital and 6-month mortality rates were 39%, 56% and 72%, respectively. A performance status ≥ 2 [odds ratio (OR) = 5.17 (95% confidence interval, CI = 1.84–14.53)], advanced cancer (TNM stage IV) [OR = 3.80 (95% CI = 1.28–11.28)], and the number of organ failures [OR=2.87 (95% CI=1.83–4.50)] were associated with increased mortality in multivariate analysis.

Conclusions

In conjunction with clinical judgment and taking into consideration the patient's preferences and values, the knowledge of these outcome predictors may be useful in helping physicians to identify patients who might benefit from the intensive care and to improve discussions on patients' prognosis.

Keywords

References

  1. Davies L, Welch HG (2006) Epidemiology of head and neck cancer in the United States. Otolaryngol Head Neck Surg 135:451–457
    • View reference on PubMed
    • View reference on publisher's website
  2. Forastiere AA, Trotti A, Pfister DG, Grandis JR (2006)Head and neck cancer: recent advances and new standards of care. J Clin Oncol 24:2603–2605
    • View reference on PubMed
    • View reference on publisher's website
  3. Downey RJ, Friedlander P, Groeger J, Kraus D, Schantz S, Spiro R, Strong E, Shaha A, Shah J (1999) Critical care for the severely ill head and neck patient. Crit Care Med 27:95–97
    • View reference on PubMed
    • View reference on publisher's website
  4. To EW, Tsang WM, Lai EC, Chu MC (2002) Retrospective study on the need of intensive care unit admission after major head and neck surgery. A N Z J Surg 72:11–14
    • View reference on publisher's website
  5. de Melo GM, Ribeiro KC, Kowalski LP, Deheinzelin D (2001) Risk factors for postoperative complications in oral cancer and their prognostic implications. Arch Otolaryngol Head Neck Surg 127:828–833
    • View reference on PubMed
  6. Godden DR, Patel M, Baldwin A, Woodwards RT (1999) Need for intensive care after operations for head and neck cancer surgery. Br J Oral Maxillofac Surg 37:502–505
    • View reference on PubMed
    • View reference on publisher's website
  7. Soares M, Salluh JI (2006) Validation of the SAPS 3 admission prognostic model in patients with cancer in need of intensive care. Intensive Care Med 32:1839–1844
  8. Le Gall J-R, Lemeshow S, Saulnier F (1993) A new simplified acute physiology score (SAPS II) based on a European/North American multicenter study. JAMA 270:2957–2963
    • View reference on PubMed
    • View reference on publisher's website
  9. Vincent JL, Moreno R, Takala J, Willatts S, De Mendonca A, Bruining H, Reinhart CK, Suter PM, Thijs LG (1996) The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med 22:707–710
    • View reference on PubMed
  10. Piccirllo JF (2001) Adult Comorbidity Evaluation-27. Comorbidity data collection form. Available at: http://oto.wustl.edu/clinepi/Forms/com_form.doc. Assessed 28 September 2004
  11. Zubrod CG, Schneiderman M, Frei III E, Brindley C, Gold GL, Shnider B, Oviedo R, Gorman J, Jones R Jr, Jonsson U, Colsky J, Chalmers T, Ferguson B, Dederick M, Holland J, Selawry O, Regelson W, Lasagna L, Owens Jr AH (1960) Appraisal of methods for the study of chemotherapy of cancer in man: comparative therapeutic trial of nitrogen mustard and triethylene thiophosphoramide. J Chron Dis 11:7–33
    • View reference on publisher's website
  12. Soares M, Salluh JI, Ferreira CG, Luiz RR, Spector N, Rocco JR (2005) Impact of two different comorbidity measures on the six-month mortality of critically ill cancer patients. Intensive Care Med 31:408–415
  13. Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, Schein RM, Sibbald WJ (1992) Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest 101:1644–1655
    • View reference on PubMed
  14. Hosmer DW, Lemeshow S (2000) Applied logistic regression, 2nd edn. Wiley-Interscience, New York
  15. Hanley JA, McNeil BJ (1982) The meaning and use of the area under receiver operating characteristic (ROC) curve. Radiology 143:29–36
    • View reference on PubMed
  16. Azoulay E, Moreau D, Alberti C, Leleu G, Adrie C, Barboteu M, Cottu P, Levy V, Le Gall J-R, Schlemmer B (2000) Predictors of short-term mortality in critically ill patients with solid malignancies. Intensive Care Med 26:1817–1823
  17. Groeger JS, Lemeshow S, Price K, Nierman DM, White P Jr, Klar J, Granovsky S, Horak D, Kish SK (1998) Multicenter outcome study of cancer patients admitted to the intensive care unit: a probability of mortality model. J Clin Oncol 16:761–770
    • View reference on PubMed
  18. Kress JP, Christenson J, Pohlman AS, Linkin DR, Hall JB (1999) Outcomes of critically ill cancer patients in a university hospital setting. Am J Respir Crit Care Med 160:1957–1961
    • View reference on PubMed
  19. Staudinger T, Stoiser B, Mullner M, Locker GJ, Laczika K, Knapp S, Burgmann H, Wilfing A, Kofler J, Thalhammer F, Frass M (2000) Outcome and prognostic factors in critically ill cancer patients admitted to the intensive care unit. Crit Care Med 28:1322–1328
    • View reference on PubMed
    • View reference on publisher's website

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