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Sun WN, Hsu HT, Huang YT, Ko NY, Chen JL. Investigating stress, social support, and decisional conflict dynamics in surrogates of intensive care unit patients with cancer. Support Care Cancer 2024; 32:722. [PMID: 39392496 DOI: 10.1007/s00520-024-08916-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2024] [Accepted: 10/01/2024] [Indexed: 10/12/2024]
Abstract
PURPOSE The purpose of this study is to examine fluctuations in stress, social support, and decisional conflict among surrogates during the admission and discharge phases of intensive care unit (ICU) patients with cancer. Additionally, this study seeks to identify the factors that influence changes in decisional conflict experienced by these surrogates. METHODS This study involved surrogates of ICU patients with cancer. Data were collected within three days of ICU admission and during the discharge phase. RESULTS The study included 115 surrogates of ICU patients with cancer. Following ICU discharge, the surrogates experienced a significant reduction in mean stress levels (t = - 7.205; p < .001), improved family support (t = 3.748; p < .001), and decreased support from healthcare professionals (t = - 3.286; p = .001). Younger surrogates, high-stress levels in surrogates, and low social support from healthcare professionals were associated with high decisional conflict. Stepwise multiple regression analysis indicated that surrogates' age, changes in stress, and changes in healthcare professionals' support explained 5%, 8%, and 16% of the variation in changes in decisional conflict, respectively. CONCLUSIONS To effectively reduce decisional conflict, particularly during the transition of patients with cancer from the ICU, a robust support system and comprehensive information on the treatment and prognosis of diseases in patients with cancer should be provided to younger surrogates. Healthcare professionals can facilitate family meetings and ensure comprehensive communication of the treatment plan. Practical guidance, social work assistance, timely clarification, and thorough information healthcare professionals provide can effectively mitigate decisional conflicts and enhance decision-making processes.
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Affiliation(s)
- Wan-Na Sun
- Department of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- College of Nursing, Chung Hwa University of Medical Technology, Tainan, Taiwan
| | - Hsin-Tien Hsu
- School of Nursing, Kaohsiung Medical University, No.100, Shih-Chuan 1st Road, Sanmin District, Kaohsiung, 80708, Taiwan.
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No.100, Tzyou 1st Road, Sanmin District, Kaohsiung, 807, Taiwan.
| | - Yu-Tung Huang
- National Center for Geriatrics and Welfare Research, National Health Research Institutes, Yunlin, Taiwan
| | - Nai-Ying Ko
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jyu-Lin Chen
- Department of Family Health Care Nursing, University of California San Francisco, San Francisco, CA, USA
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Nazer LH, Awad W, Thawabieh H, Abusara A, Abdelrahman D, Addassi A, Abuatta O, Sughayer M, Shehabi Y. Procalcitonin-Guided Management and Duration of Antibiotic Therapy in Critically Ill Cancer Patients With Sepsis (Pro-Can Study): A Randomized Controlled Trial. Crit Care Explor 2024; 6:e1173. [PMID: 39431961 PMCID: PMC11495690 DOI: 10.1097/cce.0000000000001173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2024] Open
Abstract
OBJECTIVES To evaluate the effect of procalcitonin-guided management on the duration of antibiotic therapy in critically ill cancer patients with sepsis. DESIGN Randomized, controlled, single-blinded trial. SETTING A comprehensive multidisciplinary cancer hospital in Jordan. PATIENTS Adults with cancer treated in the ICU who were started on antibiotics for suspected infection, met the SEPSIS-3 criteria, and were expected to stay in the ICU greater than or equal to 48 hours. INTERVENTIONS Patients were randomized to the procalcitonin-guided or standard care (SC) arms. All patients had procalcitonin measured daily, up to 5 days or until ICU discharge or death. For the procalcitonin arm, a procalcitonin-guided algorithm was provided to guide antibiotic management, but clinicians were allowed to override the algorithm, if clinically indicated. In the SC arm, ICU clinicians were blinded to the procalcitonin levels. MEASUREMENTS AND MAIN RESULTS Primary outcome was time to antibiotic cessation. We also evaluated the number of antibiotic-free days at 28 days, hospital discharge, or death, whichever came first, and antibiotic defined daily doses (DDDs). We enrolled 77 patients in the procalcitonin arm and 76 in the SC arm. Mean age was 58 ± 14 (sd) years, 67% were males, 74% had solid tumors, and 13% were neutropenic. Median (interquartile range [IQR]) Sequential Organ Failure Assessment scores were 7 (6-10) and 7 (5-9) and procalcitonin concentrations (ng/mL) at baseline were 3.4 (0.8-16) and 3.4 (0.5-26), in the procalcitonin and SC arms, respectively. There was no difference in the median (IQR) time to antibiotic cessation in the procalcitonin and SC arms, 8 (4-11) and 8 (5-13), respectively (p = 0.463). Median (IQR) number of antibiotic-free days were 20 (17-24) and 20 (16-23), (p = 0.484) and total DDDs were 1541.4 and 2050.4 in the procalcitonin and SC arms, respectively. CONCLUSIONS In critically ill cancer patients with sepsis, procalcitonin-guided management did not reduce the duration of antibiotic treatment.
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Affiliation(s)
| | - Wedad Awad
- King Hussein Cancer Center, Amman, Jordan
| | | | | | | | | | | | | | - Yahya Shehabi
- School of Clinical Sciences, Monash University, Melbourne, VIC, Australia
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Bosch-Compte R, Visa L, Rios A, Duran X, Fernández-Real M, Gomariz-Vilaldach G, Masclans JR. Prognostic factors in oncological patients with solid tumours requiring intensive care unit admission. Oncol Lett 2023; 26:525. [PMID: 37927417 PMCID: PMC10623089 DOI: 10.3892/ol.2023.14112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 10/05/2023] [Indexed: 11/07/2023] Open
Abstract
The aim of the present study was to identify factors predicting in-hospital mortality in patients with cancer admitted to a medical Intensive Care Unit (ICU), and to evaluate their functional status and survival during follow-up at the oncology service in the initial 12 months after hospital discharge. A retrospective observational study was performed on 129 consecutive oncological patients with solid tumours admitted to the medical ICU of the Hospital del Mar (Barcelona, Spain) between January 2016 and June 2018. Demographics, and clinical data in-ICU and in-hospital mortality were recorded. Post-hospital discharge follow-up was also carried out. ICU and hospital mortality rates were 24% (n=31) and 40.3% (n=52), respectively. Sequential Organ Failure Assessment (SOFA) score (HR, 1.20; 95% CI, 1.01-1.42; P=0.037), neutropenia on admission (HR, 8.53; 95% CI, 2.15-33.82; P=0.002), metastatic disease (HR, 3.92; 95% CI, 1.82-8.45; P<0.001), need for invasive mechanical ventilation (HR, 5.78; 95% CI, 1.61-20.73; P=0.007), surgery during hospital admission (HR, 0.23; 95% CI, 0.09-0.61; P=0.003) and ICU stay (>48 h) (HR, 0.11; 95% CI, 0.04-0.29; P<0.001) were the independent risk factors for ICU mortality. Overall, 59.5% of the survivors had good functional status at hospital discharge and 28.7% of patients with cancer admitted to the ICU were alive 1 year after hospital discharge, most of them (85.7%) with good functional status (Eastern Cooperative Oncology Group 0-1). In conclusion, hospital mortality may be associated with SOFA score at ICU admission, the need for invasive mechanical ventilation, neutropenia and metastatic disease. Only 40% of patients with oncological disease admitted to the ICU died during their hospital stay, and >50% of the survivors presented good functional status at hospital discharge. Notably, 1 year after hospital discharge, 28.7% of patients were alive, most of them with a good functional status.
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Affiliation(s)
- Raquel Bosch-Compte
- Department of Critical Care Medicine, Hospital del Mar, 08003 Barcelona, Spain
| | - Laura Visa
- Department of Medical Oncology, Hospital del Mar, 08003 Barcelona, Spain
- Network Biomedical Research Center in Cancer, Ministry of Science and Innovation, Government of Spain, 28029 Madrid, Spain
| | - Alejandro Rios
- Department of Medical Oncology, Hospital del Mar, 08003 Barcelona, Spain
| | - Xavier Duran
- Hospital del Mar Medical Research Institute Foundation, 08003 Barcelona, Spain
| | - Maria Fernández-Real
- Department of Critical Care Medicine, Hospital del Mar, 08003 Barcelona, Spain
- Hospital del Mar Medical Research Institute Foundation, 08003 Barcelona, Spain
| | - Gemma Gomariz-Vilaldach
- Department of Critical Care Medicine, Hospital del Mar, 08003 Barcelona, Spain
- Hospital del Mar Medical Research Institute Foundation, 08003 Barcelona, Spain
| | - Joan Ramon Masclans
- Department of Critical Care Medicine, Hospital del Mar, 08003 Barcelona, Spain
- Hospital del Mar Medical Research Institute Foundation, 08003 Barcelona, Spain
- Department of Medicine and Life Sciences, Pompeu Fabra University, 08002 Barcelona, Spain
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Prognostic Utility of Platelet-to-Albumin Ratio among Critically Ill Patients with Colorectal Cancer: A Propensity Score Matching Study. JOURNAL OF ONCOLOGY 2022; 2022:6107997. [PMID: 35664562 PMCID: PMC9162859 DOI: 10.1155/2022/6107997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/04/2022] [Accepted: 05/07/2022] [Indexed: 11/17/2022]
Abstract
The platelet-to-albumin ratio (PAR) was developed to evaluate inflammatory and nutritional status among patients. The primary goal of the current study was to gain insight into the prognostic role of PAR in critically ill patients with colorectal cancer (CRC). The secondary aim was to develop and verify a clinical model including PAR for the prediction of 28-day mortality. This observational, multicenter study used data from the Medical Information Mart for Intensive Care (MIMIC) IV, e-ICU databases, and Union cohort. Data from 776 critically ill patients with CRC were from the e-ICU database, 219 from the MIMC-IV database, and 135 from the Wuhan Union Hospital. Propensity score matching (PSM) analysis, along with inverse probability treatment weighting, was used to control the influence of confounding factors. Support vector machine (SVM) and LASSO Cox models were then applied to identify significant metrics associated with 28-day mortality in the test cohort. Receiver operating curve (ROC) analysis, along with sensitivity and specificity, was measured to assess the predictive performances of PAR and the survival nomogram. The threshold value for PAR was 8.6, and patients with high PAR (≥8.6) experienced higher 28-day mortality compared to those with low PAR (<8.6). ROC curve analyses revealed that the discriminative ability of PAR was better than platelet count and albumin alone. LASSO Cox regression along with SVM identified six significant metrics associated with 28-day mortality in critically ill patients with CRC, including PAR. The C-index of the critically ill CRC nomogram was 0.802 (0.744–0.859) in the e-ICU training cohort, 0.839 (0.779–0.899) in the e-ICU validation cohort, 0.787 (0.695–0.879) in the MIMIC-IV cohort, and 0.767 (0.703–0.831) in the Union cohort. PAR is a simple score that combines inflammatory and nutritional status. PAR was a reliable index to predict short-term survival outcome of critically ill patients with CRC. Moreover, a clinical nomogram incorporating PAR exhibited satisfactory performance for predicting 28-day mortality of critically ill patients with CRC.
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Understanding the Host in the Management of Pneumonia. An Official American Thoracic Society Workshop Report. Ann Am Thorac Soc 2021; 18:1087-1097. [PMID: 34242148 PMCID: PMC8328365 DOI: 10.1513/annalsats.202102-209st] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Pneumonia causes a significant burden of disease worldwide. Although all populations are at risk of pneumonia, those at extremes of age and those with immunosuppressive disorders, underlying respiratory disease, and critical illness are particularly vulnerable. Although clinical practice guidelines addressing the management and treatment of pneumonia exist, few of the supporting studies focus on the crucial contributions of the host in pneumonia pathogenesis and recovery. Such essential considerations include the host risk factors that lead to susceptibility to lung infections; biomarkers reflecting the host response and the means to pursue host-directed pneumonia therapy; systemic effects of pneumonia on the host; and long-term health outcomes after pneumonia. To address these gaps, the Pneumonia Working Group of the Assembly on Pulmonary Infection and Tuberculosis led a workshop held at the American Thoracic Society meeting in May 2018 with overarching objectives to foster attention, stimulate research, and promote funding for short-term and long-term investigations into the host contributions to pneumonia. The workshop involved participants from various disciplines with expertise in lung infection, pneumonia, sepsis, immunocompromised patients, translational biology, data science, genomics, systems biology, and clinical trials. This workshop report summarizes the presentations and discussions and important recommendations for future clinical pneumonia studies. These recommendations include establishing consensus disease and outcome definitions, improved phenotyping, development of clinical study networks, standardized data and biospecimen collection and protocols, and development of innovative trial designs.
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Martos-Benítez FD, Soler-Morejón CDD, Lara-Ponce KX, Orama-Requejo V, Burgos-Aragüez D, Larrondo-Muguercia H, Lespoir RW. Critically ill patients with cancer: A clinical perspective. World J Clin Oncol 2020; 11:809-835. [PMID: 33200075 PMCID: PMC7643188 DOI: 10.5306/wjco.v11.i10.809] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 08/09/2020] [Accepted: 09/14/2020] [Indexed: 02/06/2023] Open
Abstract
Cancer patients account for 15% of all admissions to intensive care unit (ICU) and 5% will experience a critical illness resulting in ICU admission. Mortality rates have decreased during the last decades because of new anticancer therapies and advanced organ support methods. Since early critical care and organ support is associated with improved survival, timely identification of the onset of clinical signs indicating critical illness is crucial to avoid delaying. This article focused on relevant and current information on epidemiology, diagnosis, and treatment of the main clinical disorders experienced by critically ill cancer patients.
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Affiliation(s)
| | | | | | | | | | | | - Rahim W Lespoir
- Intensive Care Unit 8B, Hermanos Ameijeiras Hospital, Havana 10300, Cuba
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Fang C, Yang L, Zeng G, Huang R, Fang W, Chen Y, Guan J, Li P, Huang X, Lin L. Treatment of syncope in tongue cancer with palliative chemotherapy in the intensive care unit: A case report. Medicine (Baltimore) 2019; 98:e16998. [PMID: 31464952 PMCID: PMC6736034 DOI: 10.1097/md.0000000000016998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Syncope caused by head and neck cancer (HNC) is rare. However, syncope caused by tongue cancer (TC) is even rarer. In TC, syncope is caused by tumor-mediated compression of the carotid sinus and stimulation of the glossopharyngeal nerve. PATIENT CONCERNS In this study, we report the case of a 48-year-old male patient who was diagnosed with advanced TC and bilateral cervical lymph node metastasis. On the third day of admission, the patient experienced recurrent syncope with hypotension and bradycardia. DIAGNOSES The patient was diagnosed with a well-differentiated squamous cell carcinoma of the tongue along with massive cervical lymph node metastasis and carotid sinus syndrome. INTERVENTIONS Initially, symptomatic treatment of syncope boosted the blood pressure and increased the heart rate. Thereafter, a temporary pacemaker was implanted. Finally, chemotherapy was used to control the tumor and relieve syncope. OUTCOMES After chemotherapy, the tongue ulcers and cervical lymph node reduced in size; syncope did not recur. LESSONS This case shows that chemotherapy may be a valid treatment option in patients with cancer-related syncope; however, the choice of chemotherapeutic drugs is critical. Intensive care provides life support to patients and creates opportunities for further treatment.
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Affiliation(s)
- Chongkai Fang
- First Clinical Medical College, Guangzhou University of Chinese Medicine
| | - Liting Yang
- First Clinical Medical College, Guangzhou University of Chinese Medicine
| | - Guangbi Zeng
- First Clinical Medical College, Guangzhou University of Chinese Medicine
| | - Ruilin Huang
- First Clinical Medical College, Guangzhou University of Chinese Medicine
| | - Wei Fang
- Department of Oral and Maxillofacial Surgery, Stomatological Hospital, Southern Medical University
| | - Yao Chen
- Cancer center, First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jieshan Guan
- Cancer center, First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Peng Li
- Cancer center, First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xuewu Huang
- Cancer center, First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Lizhu Lin
- Cancer center, First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
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Kingah P, Alzubaidi N, Yafawi JZD, Shehada E, Alshabani K, Soubani AO. Factors Associated with Mortality in Patients with a Solid Malignancy Admitted to the Intensive Care Unit - A Prospective Observational Study. J Crit Care Med (Targu Mures) 2018; 4:137-142. [PMID: 30574566 PMCID: PMC6296272 DOI: 10.2478/jccm-2018-0019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 09/30/2018] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Several studies show conflicting results regarding the prognosis and predictors of the outcome of critically ill patients with a solid malignancy. This study aims to determine the outcome of critically ill patients, admitted to a hospital, with a solid malignancy and the factors associated with the outcomes. METHODS AND MATERIALS All patients with a solid malignancy admitted to an intensive care unit (ICU) at a tertiary academic medical center were enrolled. Clinical data upon admission and during ICU stay were collected. Hospital, ICU, and six months outcomes were documented. RESULTS There were 252 patients with a solid malignancy during the study period. Urogenital malignancies were the most common (26.3%) followed by lung cancer (23.5%). Acute respiratory failure was the most common ICU diagnosis (51.6%) followed by sepsis in 46%. ICU mortality and hospital mortality were 21.8% and 34.3%. Six months mortality was 38.4%. Using multivariate analysis, acute kidney injury, OR 2.82, 95% CI 1.50-5.32 and P=0.001, use of mechanical ventilation, OR 2.67 95% CI 1.37 - 5.19 and P=0.004 and performance status of ≥2 with OR of 3.05, 95% CI of 1.5-6.2 and P= 0.002 were associated with hospital mortality. There were no differences in outcome between African American patients (53% of all patients) and other races. CONCLUSION This study reports encouraging survival rates in patients with a solid malignancy who are admitted to ICU. Patients with a poor baseline performance status require mechanical ventilation or develop acute renal failure have worse outcomes.
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Affiliation(s)
- Pascal Kingah
- Division of Pulmonary, Critical Care and Sleep Medicine, Wayne State University School of Medicine, 3990 John R, 3 Hudson, DetroitMI 48201, USA
| | - Nasser Alzubaidi
- Division of Pulmonary, Critical Care and Sleep Medicine, Wayne State University School of Medicine, 3990 John R, 3 Hudson, DetroitMI 48201, USA
| | - Jihane Zaza Dit Yafawi
- Division of Pulmonary, Critical Care and Sleep Medicine, Wayne State University School of Medicine, 3990 John R, 3 Hudson, DetroitMI 48201, USA
| | - Emad Shehada
- Division of Pulmonary, Critical Care and Sleep Medicine, Wayne State University School of Medicine, 3990 John R, 3 Hudson, DetroitMI 48201, USA
| | - Khaled Alshabani
- Division of Pulmonary, Critical Care and Sleep Medicine, Wayne State University School of Medicine, 3990 John R, 3 Hudson, DetroitMI 48201, USA
| | - Ayman O. Soubani
- Division of Pulmonary, Critical Care and Sleep Medicine, Wayne State University School of Medicine, 3990 John R, 3 Hudson, DetroitMI 48201, USA
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