PMID- 28040717
OWN - NLM
STAT- MEDLINE
DCOM- 20171016
LR  - 20190918
IS  - 1540-1413 (Electronic)
IS  - 1540-1405 (Linking)
VI  - 15
IP  - 1
DP  - 2017 Jan
TI  - Predictors of the Use of Specific Critical Care Therapies in Patients With 
      Metastatic Cancer.
PG  - 22-30
AB  - OBJECTIVE: Understanding which factors are associated with the use of critical 
      care therapies (CCTs) can help with clinical decision-making and goals of care 
      discussion. The goal of this study was to describe the predictors of CCT use (eg, 
      mechanical ventilation, tracheostomy, percutaneous endoscopic gastrostomy tube, 
      total parenteral nutrition, acute use of dialysis) in hospitalized patients with 
      metastatic cancer. METHODS: We used the 2010 California State Inpatient Databases 
      sponsored by the Agency for Healthcare Research and Quality to identify all 
      hospitalizations with a diagnosis of metastatic cancer (patients aged >/=18 years). 
      We examined the predictors of any CCT use (and invasive mechanical ventilation 
      [IMV] use), stratified by do-not-resuscitate (DNR) status, using multivariable 
      logistic regression models. RESULTS: We identified 99,085 hospitalizations 
      involving patients with metastatic cancer; 9.4% received any CCTs and 4.7% 
      received IMV. Predictors of CCT use in the no-DNR group included principal 
      diagnosis of infections (vs cancer-related), greater burden of comorbidities, and 
      presence of weight loss. Predictors of CCT use in the DNR group were similar, but 
      also included non-white races. Liver disease was also a predictor of IMV use in 
      the no-DNR group. Patients with metastatic lung cancer (vs breast and 
      genitourinary) with no DNR were more likely to receive CCT (and IMV). 
      CONCLUSIONS: Higher burden of comorbidities, weight loss, liver disease, lung 
      cancer subtype, and diagnosis of infections were associated with higher odds of 
      receiving CCTs or IMV. These findings may help clinicians determine in whom to 
      prioritize discussions around goals of care, especially in the group without a 
      DNR status.
CI  - Copyright (c) 2017 by the National Comprehensive Cancer Network.
FAU - Loh, Kah Poh
AU  - Loh KP
AD  - Division of Hematology/Oncology, James P. Wilmot Cancer Institute, University of 
      Rochester/Strong Memorial Hospital, Rochester, New York
FAU - Kansagra, Ankit
AU  - Kansagra A
AD  - Division of Hematology/Oncology, Department of Medicine, Baystate Medical Center, 
      Springfield, Massachusetts
FAU - Shieh, Meng-Shiou
AU  - Shieh MS
AD  - Department of Medicine, Tufts University School of Medicine, Springfield, 
      Massachusetts
FAU - Pekow, Penelope
AU  - Pekow P
AD  - Center for Quality of Care Research, Baystate Medical Center, Springfield, 
      Massachusetts
AD  - Department of Biostatistics and Epidemiology, University of Massachusetts, 
      Amherst, Massachusetts
FAU - Lindenauer, Peter
AU  - Lindenauer P
AD  - Department of Medicine, Tufts University School of Medicine, Springfield, 
      Massachusetts
AD  - Center for Quality of Care Research, Baystate Medical Center, Springfield, 
      Massachusetts
FAU - Stefan, Mihaela
AU  - Stefan M
AD  - Department of Medicine, Tufts University School of Medicine, Springfield, 
      Massachusetts
AD  - Center for Quality of Care Research, Baystate Medical Center, Springfield, 
      Massachusetts
FAU - Lagu, Tara
AU  - Lagu T
AD  - Department of Medicine, Tufts University School of Medicine, Springfield, 
      Massachusetts
AD  - Center for Quality of Care Research, Baystate Medical Center, Springfield, 
      Massachusetts
LA  - eng
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  - Aged
MH  - California
MH  - *Clinical Decision-Making
MH  - Comorbidity
MH  - Critical Care/*methods/statistics & numerical data
MH  - Female
MH  - Hospitalization/statistics & numerical data
MH  - Humans
MH  - Liver Diseases/complications/*therapy
MH  - Logistic Models
MH  - Male
MH  - Middle Aged
MH  - Neoplasms/complications/pathology/*therapy
MH  - Respiration, Artificial/methods/*statistics & numerical data
MH  - Resuscitation Orders
MH  - Retrospective Studies
MH  - Weight Loss
EDAT- 2017/01/04 06:00
MHDA- 2017/10/17 06:00
CRDT- 2017/01/02 06:00
PHST- 2016/07/28 00:00 [received]
PHST- 2016/09/28 00:00 [accepted]
PHST- 2017/01/02 06:00 [entrez]
PHST- 2017/01/04 06:00 [pubmed]
PHST- 2017/10/17 06:00 [medline]
AID - 15/1/22 [pii]
AID - 10.6004/jnccn.2017.0004 [doi]
PST - ppublish
SO  - J Natl Compr Canc Netw. 2017 Jan;15(1):22-30. doi: 10.6004/jnccn.2017.0004.