Lama Nazer, BCPS, PharmD, FCCM (she/her/hers)
Clinical Pharmacy Specialist
King Hussein Cancer Center
Amman, Jordan
Disclosure information not submitted.
Maria Lopez-Olivo, MD
Physician
The University of Texas MD Anderson Cancer Center, Texas, United States
Disclosure information not submitted.
John Cuenca, MD (he/him/his)
Clinical Research Assistant
The University of Texas MD Anderson Cancer Center
Houston, Texas
Disclosure information not submitted.
Anne Rain Brown, PharmD, BCCCP, FCCM
Critical Care Clinical Pharmacy Specialist
University of Texas MD Anderson Center
Houston, Texas
Disclosure information not submitted.
Khader Habash, PharmD
Pharmacist
King Hussein Cancer Center, United States
Disclosure information not submitted.
Michael Sirimaturos, BCCCP, BCNSP, PharmD
Clinical Specialist Leader - Critical Care
Houston Methodist Hospital
Houston, Texas, United States
Disclosure information not submitted.
Nada Al-Qadheeb, BCPS, PharmD, FCCM
Clinical Pharmacist
King Faisal Specialist Hospital & Research Center, United States
Disclosure information not submitted.
Heather May, BCCCP, PharmD, FCCM
Mayo Clinic
Rochester, Minnesota
Disclosure information not submitted.
Victoria Milano, BCPS, PharmD
Clinical Pharmacist
University of New Mexico Hospitals, United States
Disclosure information not submitted.
Joseph Nates, MBA, MD
Professor, Deputy Chair, Director ICUs
University of Texas MD Anderson Center
Bellaire, Texas, United States
Disclosure information not submitted.
Title: A meta-analysis evaluating outcomes of critically ill cancer patients by geographical region
Introduction: To date, no studies have evaluated the outcomes of critically ill patients with cancer based on the geographical regions. Therefore, we aimed to compare the clinical characteristics, mortality rates and reported lengths of stay among critically ill cancer patients across continents.
Methods: We searched MEDLINE, Embase, and Web of Science to identify original studies published in English between Jan 2010 and Feb 2021 reporting mortality in cancer patients treated in ICUs. We excluded studies evaluating children, those including >30% of hematopoietic stem cell transplant or post-surgical patients, and those evaluating a specific type of critical illness or stage of malignancy. Two reviewers independently selected the studies, appraised their quality, and abstracted data. Studies were classified based on the geographical area in which they were conducted. Primary outcomes were ICU and hospital mortality, and secondary outcome was ICU length of stay (LOS). We pooled effect sizes by geographical region.
Results: Among the 49,352 publications retrieved, 46 were eligible (n=110,366). Most of the published literature was from Europe (EU) (n=22), followed by North America (NA) (n=9), Asia (AS) (n=8), South America (SA) (n=5), and Oceania (OC) (n=2). The weighted mean age of patients varied among the geographical areas, with the highest in SA (69; 95% CI 67-71) and lowest in NA (58; 95% CI 55-60). The median (range) ICU LOS in days, reported per geographical region, were for OC 3.8 (3.7-4.0), NA 4.9 (3.5-9.4), SA 5.1 (3.5-6.3), AS 5.8 (4.5-23.7), and EU 6.7 (2.7-15.7). Pooled ICU mortality rates were for OC 26% (95% CI 22%-30%), NA 33% (95% CI 26%-40%), SA 37% (95% CI 14%-64%), EU 38% (95% CI 33%-43%), and AS 47% (95% CI 28%-57%). Pooled hospital mortality rates were for NA 37% (95% CI 31%- 43%), OC 40% (95% CI 35%-44%), EU 45% (95% CI 40%-50%), SA 46% (95% CI 23%-69%), and AS 54% (95% CI 37%-71%).
Conclusion: There was wide variability in critically ill cancer patients’ mortality rates among the geographical regions. This may be related to variations in the study inclusion criteria, ICU admission policies and access, and the severity of illness. Compared to the rest of the world, there was a disproportionately higher amount of publications from EU.