Intensive Care, Survival, and Expense of Treating Critically III Cancer Patients

Abstract

Objective. —To determine the survival and factors affecting the survival of patients with solid tumors and hematologic cancers who were admitted to the intensive care unit, the time these patients spent at home (meaningful survival) before they died, and the cost per year of life gained and per year of life gained at home. Design. —Survival and cost-effectiveness analysis. Setting. —A tertiary-care cancer center at a university medical center. Patients. —Every patient admitted to the intensive care unit between July 1, 1988, and June 30,1990, was entered into the study. This group comprised 83 patients with solid tumors and 64 patients with hematologic cancers. Main Outcome Measures. —Factors affecting survival, such as age, sex, malignancy, length of stay in the intensive care unit, and necessity for mechanical ventilator assistance, as well as cost per year of life gained and cost per year of life gained at home. Results. —The only factor that significantly affected survival was the requirement for mechanically assisted ventilation for patients with hematologic cancers. More than three fourths of the patients in either group spent less than 3 months at home before dying. The cost per year of life gained for patients with solid tumors was $82 845 and for patients with hematologic cancers was $189 339. The cost per year of life gained at home was $95142 for patients with solid tumors and $449 544 for patients with hematologic cancers. Conclusion. —The majority of patients with solid tumors and hematologic cancers admitted to the intensive care unit die before discharge, or, if they survive the hospital admission, they spend a minimal amount of time at home before dying. This limited survival is achieved at considerable cost. Physicians who treat patients with neoplastic disease should discuss potential outcomes and the possibility of withdrawing life-supportive therapy if appropriate with the patient and family, so that a reasonable strategy can be agreed on before the initiation of therapy. (JAMA. 1993;269:783-786)