PMID- 27496114
OWN - NLM
STAT- MEDLINE
DCOM- 20171019
LR  - 20191210
IS  - 1540-1413 (Electronic)
IS  - 1540-1405 (Print)
IS  - 1540-1405 (Linking)
VI  - 14
IP  - 8
DP  - 2016 Aug
TI  - Predictors of In-Hospital Mortality in Patients With Metastatic Cancer Receiving 
      Specific Critical Care Therapies.
PG  - 979-87
AB  - BACKGROUND: In-hospital mortality is high for critically ill patients with 
      metastatic cancer. To help patients, families, and clinicians make an informed 
      decision about invasive medical treatments, we examined predictors of in-hospital 
      mortality among patients with metastatic cancer who received critical care 
      therapies (CCTs). PATIENTS AND METHODS: We used the 2010 California Healthcare 
      Cost and Utilization Project: State Inpatient Databases to identify admissions of 
      patients with metastatic cancer (age >/=18 years) who received CCTs, including 
      invasive mechanical ventilation (IMV), tracheostomy, percutaneous endoscopic 
      gastrostomy (PEG) tube, acute use of dialysis, and total parenteral nutrition 
      (TPN). We first described the characteristics and outcomes of patients who 
      received any CCTs. We then used multivariable logistic regression models with 
      generalized estimating equations (to account for clustering within hospitals) to 
      identify predictors of in-hospital mortality among patients who received any 
      CCTs. RESULTS: For 2010, we identified 99,085 admissions among patients with 
      metastatic cancer. Of these, 9,348 (9.4%) received any CCT during 
      hospitalization; 50% received IMV, 15% PEG tube, 8% tracheostomy, 40% TPN, and 8% 
      acute dialysis. Inpatient mortality was 30%. Of patients who received any CCT and 
      survived to discharge, 27% were discharged to a skilled nursing facility. 
      Compared with patients who died, costs of care were $3,019 higher for admissions 
      in which patients survived the hospitalization. Predictors of in-hospital 
      mortality included non-white race (vs whites), lack of insurance (vs Medicare), 
      unscheduled admissions, principal diagnosis of infections (vs cancer-related), 
      greater burden of comorbidities, end-stage renal disease, liver disease and lung 
      cancer (vs other cancers). CONCLUSIONS: Although more studies are needed to 
      better understand risks and benefits of specific treatments in the setting of 
      specific cancer types, these data will help to inform decision-making for 
      patients with metastatic cancer who become critically ill.
CI  - Copyright (c) 2016 by the National Comprehensive Cancer Network.
FAU - Loh, Kah Poh
AU  - Loh KP
AD  - From the Division of Hematology/Oncology, James P. Wilmot Cancer Institute, 
      University of Rochester/Strong Memorial Hospital, Rochester, New York; Division 
      of Hematology/Oncology, Department of Medicine, Baystate Medical Center, 
      Springfield, Massachusetts; Department of Medicine, Tufts University School of 
      Medicine, Springfield, Massachusetts; Center for Quality of Care Research, 
      Baystate Medical Center, Springfield, Massachusetts; and Department of 
      Biostatistics and Epidemiology, University of Massachusetts, Amherst, 
      Massachusetts.
FAU - Kansagra, Ankit
AU  - Kansagra A
AD  - From the Division of Hematology/Oncology, James P. Wilmot Cancer Institute, 
      University of Rochester/Strong Memorial Hospital, Rochester, New York; Division 
      of Hematology/Oncology, Department of Medicine, Baystate Medical Center, 
      Springfield, Massachusetts; Department of Medicine, Tufts University School of 
      Medicine, Springfield, Massachusetts; Center for Quality of Care Research, 
      Baystate Medical Center, Springfield, Massachusetts; and Department of 
      Biostatistics and Epidemiology, University of Massachusetts, Amherst, 
      Massachusetts.
FAU - Shieh, Meng-Shiou
AU  - Shieh MS
AD  - From the Division of Hematology/Oncology, James P. Wilmot Cancer Institute, 
      University of Rochester/Strong Memorial Hospital, Rochester, New York; Division 
      of Hematology/Oncology, Department of Medicine, Baystate Medical Center, 
      Springfield, Massachusetts; Department of Medicine, Tufts University School of 
      Medicine, Springfield, Massachusetts; Center for Quality of Care Research, 
      Baystate Medical Center, Springfield, Massachusetts; and Department of 
      Biostatistics and Epidemiology, University of Massachusetts, Amherst, 
      Massachusetts.
FAU - Pekow, Penelope
AU  - Pekow P
AD  - From the Division of Hematology/Oncology, James P. Wilmot Cancer Institute, 
      University of Rochester/Strong Memorial Hospital, Rochester, New York; Division 
      of Hematology/Oncology, Department of Medicine, Baystate Medical Center, 
      Springfield, Massachusetts; Department of Medicine, Tufts University School of 
      Medicine, Springfield, Massachusetts; Center for Quality of Care Research, 
      Baystate Medical Center, Springfield, Massachusetts; and Department of 
      Biostatistics and Epidemiology, University of Massachusetts, Amherst, 
      Massachusetts. From the Division of Hematology/Oncology, James P. Wilmot Cancer 
      Institute, University of Rochester/Strong Memorial Hospital, Rochester, New York; 
      Division of Hematology/Oncology, Department of Medicine, Baystate Medical Center, 
      Springfield, Massachusetts; Department of Medicine, Tufts University School of 
      Medicine, Springfield, Massachusetts; Center for Quality of Care Research, 
      Baystate Medical Center, Springfield, Massachusetts; and Department of 
      Biostatistics and Epidemiology, University of Massachusetts, Amherst, 
      Massachusetts.
FAU - Lindenauer, Peter
AU  - Lindenauer P
AD  - From the Division of Hematology/Oncology, James P. Wilmot Cancer Institute, 
      University of Rochester/Strong Memorial Hospital, Rochester, New York; Division 
      of Hematology/Oncology, Department of Medicine, Baystate Medical Center, 
      Springfield, Massachusetts; Department of Medicine, Tufts University School of 
      Medicine, Springfield, Massachusetts; Center for Quality of Care Research, 
      Baystate Medical Center, Springfield, Massachusetts; and Department of 
      Biostatistics and Epidemiology, University of Massachusetts, Amherst, 
      Massachusetts. From the Division of Hematology/Oncology, James P. Wilmot Cancer 
      Institute, University of Rochester/Strong Memorial Hospital, Rochester, New York; 
      Division of Hematology/Oncology, Department of Medicine, Baystate Medical Center, 
      Springfield, Massachusetts; Department of Medicine, Tufts University School of 
      Medicine, Springfield, Massachusetts; Center for Quality of Care Research, 
      Baystate Medical Center, Springfield, Massachusetts; and Department of 
      Biostatistics and Epidemiology, University of Massachusetts, Amherst, 
      Massachusetts.
FAU - Stefan, Mihaela
AU  - Stefan M
AD  - From the Division of Hematology/Oncology, James P. Wilmot Cancer Institute, 
      University of Rochester/Strong Memorial Hospital, Rochester, New York; Division 
      of Hematology/Oncology, Department of Medicine, Baystate Medical Center, 
      Springfield, Massachusetts; Department of Medicine, Tufts University School of 
      Medicine, Springfield, Massachusetts; Center for Quality of Care Research, 
      Baystate Medical Center, Springfield, Massachusetts; and Department of 
      Biostatistics and Epidemiology, University of Massachusetts, Amherst, 
      Massachusetts. From the Division of Hematology/Oncology, James P. Wilmot Cancer 
      Institute, University of Rochester/Strong Memorial Hospital, Rochester, New York; 
      Division of Hematology/Oncology, Department of Medicine, Baystate Medical Center, 
      Springfield, Massachusetts; Department of Medicine, Tufts University School of 
      Medicine, Springfield, Massachusetts; Center for Quality of Care Research, 
      Baystate Medical Center, Springfield, Massachusetts; and Department of 
      Biostatistics and Epidemiology, University of Massachusetts, Amherst, 
      Massachusetts.
FAU - Lagu, Tara
AU  - Lagu T
AD  - From the Division of Hematology/Oncology, James P. Wilmot Cancer Institute, 
      University of Rochester/Strong Memorial Hospital, Rochester, New York; Division 
      of Hematology/Oncology, Department of Medicine, Baystate Medical Center, 
      Springfield, Massachusetts; Department of Medicine, Tufts University School of 
      Medicine, Springfield, Massachusetts; Center for Quality of Care Research, 
      Baystate Medical Center, Springfield, Massachusetts; and Department of 
      Biostatistics and Epidemiology, University of Massachusetts, Amherst, 
      Massachusetts. From the Division of Hematology/Oncology, James P. Wilmot Cancer 
      Institute, University of Rochester/Strong Memorial Hospital, Rochester, New York; 
      Division of Hematology/Oncology, Department of Medicine, Baystate Medical Center, 
      Springfield, Massachusetts; Department of Medicine, Tufts University School of 
      Medicine, Springfield, Massachusetts; Center for Quality of Care Research, 
      Baystate Medical Center, Springfield, Massachusetts; and Department of 
      Biostatistics and Epidemiology, University of Massachusetts, Amherst, 
      Massachusetts.
LA  - eng
GR  - K01 HL114631/HL/NHLBI NIH HHS/United States
GR  - K01 HL114745/HL/NHLBI NIH HHS/United States
PT  - Journal Article
PL  - United States
TA  - J Natl Compr Canc Netw
JT  - Journal of the National Comprehensive Cancer Network : JNCCN
JID - 101162515
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - California/epidemiology/ethnology
MH  - *Critical Care/methods
MH  - Databases, Factual
MH  - Female
MH  - Health Care Costs
MH  - *Hospital Mortality
MH  - Humans
MH  - Length of Stay
MH  - Male
MH  - Middle Aged
MH  - Neoplasm Metastasis
MH  - Neoplasms/diagnosis/epidemiology/*mortality/*therapy
MH  - Odds Ratio
MH  - Outcome Assessment, Health Care
MH  - Patient Acceptance of Health Care
MH  - Patient Discharge
MH  - Prognosis
PMC - PMC5642971
MID - NIHMS908655
COIS- The remaining authors have disclosed that they have no financial interests, 
      arrangements, affiliations, or commercial interests with the manufacturers of any 
      products discussed in this article or their competitors.
EDAT- 2016/08/09 06:00
MHDA- 2017/10/20 06:00
PMCR- 2017/10/16
CRDT- 2016/08/07 06:00
PHST- 2016/02/20 00:00 [received]
PHST- 2016/04/20 00:00 [accepted]
PHST- 2016/08/07 06:00 [entrez]
PHST- 2016/08/09 06:00 [pubmed]
PHST- 2017/10/20 06:00 [medline]
PHST- 2017/10/16 00:00 [pmc-release]
AID - 14/8/979 [pii]
AID - 10.6004/jnccn.2016.0105 [doi]
PST - ppublish
SO  - J Natl Compr Canc Netw. 2016 Aug;14(8):979-87. doi: 10.6004/jnccn.2016.0105.