Lama Nazer, BCPS, PharmD, FCCM (she/her/hers)
Clinical Pharmacy Specialist
King Hussein Cancer Center
Amman, Jordan
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.
John Cuenca, MD (he/him/his)
Clinical Research Assistant
The University of Texas MD Anderson Cancer Center
Houston, Texas
Disclosure information not submitted.
Maria Lopez-Olivo, MD
Physician
The University of Texas MD Anderson Cancer Center, Texas, 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.
Khader Habash, PharmD
Pharmacist
King Hussein Cancer Center, 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: Systematic Review and Meta-Analysis of Mortality in Cancer Patients Treated in Intensive Care Units
Introduction: There is large variability in the reported mortality rates for cancer patients treated in intensive care units (ICUs), thus generating difficulties in understanding their prognosis. Therefore, we aimed to synthesize the evidence from the past 11 years to characterize the mortality rates of this patient population.
Methods: A literature search using PubMed, Embase, and Web of Sciences was conducted to identify studies evaluating ICU or hospital mortality in critically ill cancer patients, published in English, between January 2010 and February 2021. We excluded studies involving pediatrics or including >30% of hematopoietic stem cell transplant patients or post-surgical patients, and those that evaluated a specific type of critical illness, stage of malignancy, or age group. Study selection, risk of bias assessment and data collection were done independently by 2 reviewers. Risk of bias was assessed using the Newcastle-Ottawa scale (NOS). Data abstracted included patients with neutropenia, thrombocytopenia, mechanical ventilation, dialysis, and using vasopressor/inotropes. A random-effects model was performed to pool outcome data. The protocol of this study was registered on PROSPERO (CRD42020179233).
Results: Among the 49,352 citations retrieved, 46 were eligible. Most studies were retrospective and single-centered. All studies had NOS score ≥7. A total of 110,366 patients were included (70,759 with solid tumors, 39,607 with hematological malignancies). The mean age was 64 years (95% CI, 62-65). Neutropenia was reported in 5.7-62.7%, thrombocytopenia in 2.3-83.4%, mechanical ventilation in 18-85.3%, dialysis in 1.7-40.3%, and the use of vasopressors/inotropes in 19.7-77.5% of the patients. Pooled ICU and hospital mortality rates were 38% (95% CI 33%-42%; 41 studies) and 45% (95% CI, 41%-49%; 36 studies), respectively. In studies directly comparing patients with hematological cancer to the solid tumors, those with hematological malignancies were more likely to die in the ICU (RR 1.4; 95% CI, 1.1-1.7; 10 studies) and hospital (RR 1.4; 95% CI 1.1 to 1.8; 7 studies).
Conclusions: In this large meta-analysis evaluating critically ill cancer patients, ICU and hospital mortality were high . Mortality was significantly higher in patients with hematological cancer compared to solid tumors.