CHEST
Original ResearchAggressiveness of Intensive Care Use Among Patients With Lung Cancer in the Surveillance, Epidemiology, and End Results-Medicare Registry
Section snippets
Design
We conducted a retrospective cohort study examining the Surveillance, Epidemiology, and End Results (SEER)-Medicare registry, a publically available database provided by the National Cancer Institute.12 The SEER program collects extensive information, including cancer type, histology, and stage of disease, for patients given a diagnosis of cancer living in one of the SEER geographic regions. Through its links to Medicare, the SEER-Medicare registry provides a comprehensive way to assess
Results
Of the 175,756 patients with lung cancer, 49,373 patients (28%) had at least one ICU admission for reasons other than surgical resection of their lung cancer, and 90,675 patients (52%) had at least one non-ICU hospitalization (Table 1). Among patients with an ICU admission, 15,932 involved a stay in an intermediate ICU. Compared with patients hospitalized outside an ICU, patients in an ICU were more often younger, male, and of nonwhite race. Patients in an ICU also had a greater median annual
Discussion
We demonstrated that between 1992 and 2005, there was close to a 40% increase in the use of ICUs for the care of elderly patients with lung cancer hospitalized for reasons other than resection of their tumor. Increases in ICU admission were greatest among individuals not requiring MV, as well as among those hospitalized in intermediate units rather than in full-service ICUs. Most patients were hospitalized in an ICU for reasons directly related to their underlying lung cancer, but diagnoses of
Conclusions
In summary, we found that growth in the use of the ICU for patients with lung cancer over time is greatest among patients admitted to intermediate ICUs, a location where more elderly were admitted relative to other ICU types. Lung cancer was a common reason to be admitted to the ICU, but respiratory failure and sepsis as causes for ICU admission are increasing. ICU use was more common among patients who were younger and those who had greater comorbid illness, as well as those with nondistant
Acknowledgments
Author contributions: C. R. C. and C. G. S. contributed to the conception of the study and drafting or revision of the manuscript for important intellectual content and take full responsibility for the content of the manuscript, including the integrity of the data and the accuracy of the analysis. L. C. F. and R. S. W. contributed to the interpretation of the data and revision of the manuscript for important intellectual content; C. R. C., M. E. O., and C. G. S. contributed to the data
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2020, Journal of Pain and Symptom ManagementCitation Excerpt :The study population included patients 75 years and older admitted to the ICU between 2008 and 2012. We focused on patients older than 75 years to be consistent with NQF quality metrics and because previous research has demonstrated high mortality and morbidity associated with ICU admission in this population.24–26 The study institution has five distinct ICUs: medical, cardiac, surgical, trauma surgery, and cardiac surgery.
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2017, American Journal of Kidney DiseasesThe influence of race/ethnicity and education on family ratings of the quality of dying in the ICU
2016, Journal of Pain and Symptom ManagementCitation Excerpt :These findings support previous studies reporting lower quality of end-of-life care as experienced by minority patients whether measured by ratings provided by bereaved family member ratings in a variety of settings,20 with processes of care measures such as concordance between preferences and care received,13,14 or the decedent's receipt of palliative care measures.32 Given the already high but increasing proportion of deaths that occur in or shortly after a stay in the ICU,36–39 this additional documentation of racial/ethnic variability in ratings of QODD in the ICU reinforces the need to identify and remedy differences that may be attributable to disparities rather than preferences. In contrast to our finding of differences by race/ethnicity, we did not find an association between educational attainment and family members' quality of end-of-life ratings, controlling for race/ethnicity.
FUNDING/SUPPORT: This work was supported in part by the Agency for Healthcare Research and Quality [Grant K08 HS020672 to Dr Cooke], the National Cancer Institute [Grant K07 CA138772 to Dr Wiener], the National Heart, Lung and Blood Institute [Grant K23 HL111116 to Dr Feemster], and the Department of Veterans Affairs [to Drs Wiener and Feemster].
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