Introduction
Materials and methods
Study population and data sets
Statistical analysis
Determinants or prognostic factors of survival
Survival analysis and estimation of life expectancy
Estimation of quality-adjusted life expectancy
Results
Patient characteristics
Duration of mechanical ventilation | |||||||
---|---|---|---|---|---|---|---|
>7 days (extended MV) | >21 days (prolonged MV) | ||||||
Variables |
N
| Median survival, months (IQR) | 1-yr survival rate, % (95% CI) |
N
| Median survival, months (IQR) | 1-yr survival rate, % (95% CI) | Life expectancy, yr (SE) |
Total | 9,011 | 1.54 (0.67 to 5.90) | 17.6 (16.8 to 18.4) | 5138 | 1.37 (0.50 to 4.57) | 14.3 (13.3 to 15.3) | 1.21 (0.10) |
Gender and age (yr) | |||||||
Male | |||||||
17 to 64 | 2,282 | 1.64 (0.66 to 8.29) | 20.4 (18.8 to 22.2) | 1,010 | 1.17 (0.43 to 3.73) | 13.9 (11.8 to 16.2) | 1.52 (0.22) |
65 to 74 | 1,686 | 1.50 (0.67 to 5.10) | 16.7 (14.9 to 18.5) | 986 | 1.37 (0.50 to 4.23) | 12.8 (10.8 to 15.1) | 1.02 (0.13) |
75 to 84 | 1,729 | 1.50 (0.70 to 4.94) | 15.1 (13.4 to 16.9) | 1,116 | 1.40 (0.53 to 4.63) | 13.3 (11.3 to 15.4) | 0.86 (0.09) |
85 or older | 425 | 1.64 (0.77 to 4.50) | 14.9 (11.6 to 18.6) | 318 | 1.80 (0.63 to 4.73) | 16.4 (12.4 to 20.9) | 0.95 (0.19) |
Female | |||||||
17 to 64 | 1,129 | 1.40 (0.60 to 6.84) | 19.8 (17.5 to 22.3) | 573 | 1.30 (0.43 to 5.43) | 17.2 (14.2 to 20.5) | 1.49 (0.31) |
65 to 74 | 788 | 1.54 (0.64 to 5.27) | 17.2 (14.6 to 20.0) | 459 | 1.40 (0.63 to 4.53) | 13.9 (10.9 to 17.3) | 1.03 (0.24) |
75 to 84 | 727 | 1.50 (0.67 to 5.50) | 14.3 (11.8 to 17.1) | 499 | 1.47 (0.57 to 5.83) | 14.8 (11.7 to 18.2) | 1.07 (0.30) |
85 or older | 234 | 1.84 (0.86 to 6.67) | 17.6 (12.9 to 23.0) | 177 | 1.70 (0.73 to 6.20) | 16.4 (11.1 to 22.6) | 0.82 (0.24) |
Extent of cancer | |||||||
Local | 5,954 | 1.87 (0.79 to 8.32) | 20.6 (19.5 to 21.7) | 3,900 | 1.60 (0.57 to 5.97) | 16.9 (15.7 to 18.2) | 1.36 (0.11) |
Metastasis | 3,057 | 1.07 (0.50 to 3.12) | 11.7 (10.6 to 12.9) | 1,238 | 0.93 (0.37 to 2.10) | 5.9 (4.6 to 7.3) | 0.64 (0.15) |
Cancer type | |||||||
Head and neck | 1,432 | 2.60 (0.89 to 13.32) | 26.0 (23.7 to 28.3) | 705 | 1.77 (0.70 to 7.57) | 20.0 (17.0 to 23.1) | 1.57 (0.45) |
Bone and connective tissue | 52 | 1.37 (0.77 to 2.74) | 10.0 (3.7 to 20.1) | 38 | 0.87 (0.37 to 1.77) | 2.8 (2.1 to 12.2) | -b |
Liver | 775 | 0.87 (0.40 to 2.50) | 10.5 (8.4 to 12.8) | 297 | 1.00 (0.40 to 2.43) | 6.8 (4.2 to 10.2) | 0.45 (0.19) |
Lung | 1,752 | 1.10 (0.56 to 2.93) | 10.5 (9.1 to 12.1) | 965 | 1.00 (0.37 to 2.57) | 6.6 (5.1 to 8.3) | 0.77 (0.13) |
Esophagus | 495 | 2.07 (0.86 to 9.17) | 22.5 (18.8 to 26.3) | 232 | 1.03 (0.47 to 2.83) | 10.2 (6.6 to 14.6) | 0.98 (0.33) |
Lymphatic and hematopoietic tissue | 578 | 1.20 (0.57 to 4.47) | 14.2 (11.5 to 17.2) | 289 | 1.27 (0.43 to 4.33) | 14.3 (10.4 to 18.7) | 1.12 (0.36) |
Urinary organs | 420 | 1.74 (0.90 to 4.94) | 16.0 (12.6 to 19.8) | 306 | 1.30 (0.60 to 3.87) | 12.8 (9.2 to 16.9) | 0.88 (0.22) |
Female genital | 345 | 1.37 (0.67 to 5.37) | 17.2 (13.4 to 21.5) | 214 | 1.23 (0.50 to 5.23) | 14.1 (9.8 to 19.3) | 0.98 (0.63) |
Pancreas and other GI organs | 176 | 1.27 (0.61 to 3.57) | 13.2 (8.6 to 18.7) | 99 | 1.33 (0.43 to 4.90) | 15.1 (8.9 to 22.9) | -b |
Stomach | 503 | 1.57 (0.74 to 5.44) | 17.7 (14.4 to 21.3) | 305 | 1.60 (0.60 to 5.60) | 17.0 (12.9 to 21.6) | 0.98 (0.38) |
Thyroid | 77 | 1.81 (0.87 to 10.34) | 24.9 (15.7 to 35.2) | 56 | 1.27 (0.50 to 5.17) | 18.6 (9.5 to 30.0) | -b |
Breast | 375 | 1.40 (0.57 to 4.97) | 17.1 (13.3 to 21.3) | 223 | 1.40 (0.60 to 6.47) | 18.9 (13.8 to 24.6) | 1.17 (0.48) |
Skin | 100 | 2.30 (0.97 to 9.10) | 21.3 (13.7 to 30.0) | 83 | 1.83 (0.60 to 6.33) | 18.1 (10.6 to 27.3) | -b |
Brain and nervous system | 280 | 2.40 (1.17 to 7.60) | 18.0 (13.5 to 23.0) | 228 | 1.97 (0.83 to 7.13) | 15.8 (11.2 to 21.2) | 1.18 (0.50) |
Colorectal | 1,019 | 1.91 (0.80 to 9.60) | 22.8 (20.2 to 25.5) | 650 | 1.77 (0.60 to 7.07) | 18.8 (15.8 to 22.0) | 1.47 (0.23) |
Male genital | 435 | 1.81 (0.77 to 7.14) | 18.6 (14.9 to 22.5) | 303 | 2.17 (0.70 to 9.20) | 19.9 (15.4 to 24.8) | 1.15 (0.41) |
Others | 197 | 1.47 (0.77 to 7.30) | 20.8 (15.3 to 26.7) | 145 | 1.03 (0.40 to 3.70) | 14.9 (9.5 to 21.3) | -b |
Acute comorbidities | |||||||
Acute renal failure | 630 | 0.90 (0.50 to 1.80) | 7.4 (5.4 to 9.8) | 359 | 0.90 (0.37 to 1.93) | 8.4 (5.6 to 11.9) | 0.44 (0.20) |
Septicemia | 2,013 | 1.02 (0.56 to 2.40) | 9.8 (8.5 to 11.2) | 1,155 | 0.93 (0.37 to 2.60) | 10.2 (8.5 to 12.2) | 0.94 (0.24) |
Shock | 1,038 | 0.89 (0.44 to 2.07) | 9.0 (7.3 to 10.8) | 547 | 0.87 (0.33 to 2.40) | 9.4 (7.0 to 12.1) | 0.96 (0.20) |
GI hemorrhage | 941 | 1.40 (0.60 to 4.70) | 15.0 (12.8 to 17.4) | 559 | 1.20 (0.40 to 4.27) | 14.2 (11.4 to 17.3) | 1.12 (0.26) |
Other injury and poisoning | 729 | 2.90 (1.00 to 16.57) | 28.4 (25.1 to 31.8) | 392 | 2.07 (0.77 to 8.50) | 21.8 (17.7 to 26.1) | 1.61 (0.45) |
Cerebrovascular disease | 592 | 2.37 (0.89 to 12.14) | 25.2 (21.7 to 28.9) | 426 | 2.67 (0.83 to 12.23) | 25.0 (20.8 to 29.4) | 1.61 (0.38) |
Concurrent organ disorder (chronic comorbidities) | |||||||
Hypertension | 615 | 2.60 (0.89 to 16.04) | 27.3 (23.7 to 31.0) | 354 | 2.20 (0.80 to 8.90) | 21.7 (17.3 to 26.4) | 1.83 (0.44) |
COPD | 615 | 2.10 (0.87 to 9.97) | 23.0 (19.6 to 26.4) | 428 | 2.00 (0.67 to 8.73) | 20.6 (16.8 to 24.6) | 1.34 (0.38) |
Hospital level | |||||||
District | 977 | 1.40 (0.63 to 4.04) | 12.6 (10.5 to 14.8) | 694 | 1.40 (0.57 to 5.03) | 14.3 (11.7 to 17.1) | 1.17 (0.31) |
Regional | 3,058 | 1.44 (0.64 to 4.57) | 14.4 (13.2 to 15.8) | 1,772 | 1.27 (0.50 to 3.87) | 12.2 (10.7 to 13.8) | 1.04 (0.22) |
Medical center | 4,976 | 1.67 (0.70 to 8.02) | 20.5 (19.3 to 21.6) | 2,672 | 1.40 (0.53 to 5.07) | 15.6 (14.2 to 17.1) | 1.37 (0.18) |
Incidence of prolonged mechanical ventilation
Type of cancer | Number of ICU admissions | Incidence of PMV per 100 ICU admissions (95% CI) | QALE in QALY units (SE) | |
---|---|---|---|---|
Partial cognition | Poor cognition | |||
Lung | 6,114 | 14.9 (8.4 to 23.5) | 0.23 (0.06) | 0.11 (0.03) |
Others | 608 | 14.3 (8.4 to 23.5) | -b | -b |
Male genital | 2,197 | 14.2 (8.4 to 23.5) | 0.33 (0.14) | 0.15 (0.06) |
Brain & nervous system | 1,490 | 14.0 (7.7 to 24.5) | 0.35 (0.19) | 0.16 (0.08) |
Lymphatic and hematopoietic tissue | 2,242 | 13.3 (7.7 to 22.2) | 0.35 (0.16) | 0.16 (0.06) |
Esophagus | 1,781 | 13.0 (6.9 to 22.2) | 0.30 (0.13) | 0.14 (0.07) |
Skin | 579 | 13.1 (7.7 to 22.2) | -b | -b |
Thyroid | 432 | 12.3 (6.9 to 21.0) | -b | -b |
Stomach | 2,647 | 11.1 (6.2 to 19.7) | 0.28 (0.13) | 0.13 (0.04) |
Colorectal | 6,213 | 10.6 (5.5 to 18.4) | 0.45 (0.11) | 0.20 (0.06) |
Urinary organs | 2,883 | 10.4 (5.5 to 18.4) | 0.26 (0.08) | 0.12 (0.04) |
Bone and connective tissue | 339 | 10.3 (5.5 to 18.4) | -b | -b |
Breast | 2,072 | 9.9 (4.8 to 17.1) | 0.34 (0.17) | 0.16 (0.06) |
Head and neck | 7,074 | 8.8 (4.1 to 15.8) | 0.48 (0.21) | 0.22 (0.08) |
Female genital | 2,342 | 8.5 (4.1 to 15.8) | 0.28 (0.23) | 0.12 (0.11) |
Pancreas and other GI organs | 1,097 | 8.0 (3.5 to 15.8) | -b | -b |
Liver | 6,625 | 4.3 (1.6 to 10.2) | 0.12 (0.07) | 0.06 (0.02) |
Survival rate, life expectancy and quality-adjusted life expectancy
Prognostic factors
Variables | Risk of death | |
---|---|---|
Crude HR (95% CI) | Adjusted HRb(95% CI) | |
Gender | ||
Female | 1.00 | 1.00 |
Male | 1.07 (1.01 to 1.14) | 1.12 (1.04 to 1.20) |
Age (yr) | ||
17 to 64 | 1.00 | 1.00 |
65 to 74 | 0.99 (0.92 to 1.07) | 0.99 (0.91 to 1.07) |
75 to 84 | 0.96 (0.89 to 1.03) | 1.02 (0.94 to 1.10) |
85 or older | 0.90 (0.81 to 1.01) | 0.98 (0.87 to 1.10) |
Extent of cancer | ||
Local | 1.00 | 1.00 |
Metastatic | 1.56 (1.45 to 1.66) | 1.53 (1.42 to 1.65) |
Cancer type | ||
Head and neck | 1.00 | 1.00 |
Bone and connective tissue | 2.08 (1.49 to 2.90) | 2.06 (1.48 to 2.88) |
Liver | 1.65 (1.43 to 1.90) | 1.55 (1.34 to 1.78) |
Lung | 1.58 (1.42 to 1.75) | 1.45 (1.30 to 1.61) |
Esophagus | 1.44 (1.23 to 1.69) | 1.32 (1.13 to 1.54) |
Lymphatic and hematopoietic tissue | 1.26 (1.09 to 1.45) | 1.32 (1.14 to 1.52) |
Urinary organs | 1.23 (1.07 to 1.43) | 1.24 (1.07 to 1.43) |
Female genital | 1.19 (1.01 to 1.40) | 1.23 (1.03 to 1.46) |
Pancreas and other GI organs | 1.19 (0.96 to 1.48) | 1.17 (0.94 to 1.47) |
Thyroid | 1.14 (0.86 to 1.52) | 1.17 (0.88 to 1.56) |
Breast | 1.10 (0.94 to 1.29) | 1.14 (0.96 to 1.35) |
Skin | 1.07 (0.84 to 1.36) | 1.08 (0.84 to 1.38) |
Stomach | 1.09 (0.9 to 1.26) | 1.08 (0.93 to 1.25) |
Brain and nervous system | 1.01 (0.8 to 1.19) | 1.04 (0.89 to 1.22) |
Colorectal | 1.05 (0.93 to 1.17) | 1.04 (0.92 to 1.17) |
Male genital | 0.95 (0.82 to 1.10) | 0.93 (0.80 to 1.09) |
Others | 1.28 (1.06 to 1.54) | 1.14 (0.95 to 1.39) |
Acute comorbiditiesc | ||
Acute renal failure | 1.43 (1.28 to 1.60) | 1.46(1.30 to 1.64) |
Septicemia | 1.33 (1.24 to 1.43) | 1.24(1.15 to 1.34) |
Shock | 1.32 (1.21 to 1.45) | 1.22(1.10 to 1.34) |
GI hemorrhage | 1.07 (0.98 to 1.18) | 1.10(1.01 to 1.21) |
Other injury and poisoning | 0.78 (0.70 to 0.87) | 0.83 (0.74 to 0.92) |
Cerebrovascular disease | 0.69 (0.62 to 0.77) | 0.78 (0.69 to 0.87) |
Concurrent organ disorder (chronic comorbidities) C | ||
Hypertension | 0.74 (0.65 to 0.83) | 0.82 (0.73 to 0.93) |
COPD | 0.81 (0.73 to 0.91) | 0.88 (0.79 to 0.98) |
Hospital level | ||
District | 1.00 | 1.00 |
Regional | 1.12 (1.02 to 1.23) | 1.02 (0.93 to 1.12) |
Medical center | 1.00 (0.91 to 1.09) | 0.91 (0.83 to 1.00) |
Discussion
Conclusions
Key messages
-
Half of cancer patients under PMV survived less than 1.4 months, and the overall 1-yr survival rate was 14.3%.
-
Cancer of the liver and lung and metastasis independently predict shorter survival.
-
We recommend that palliative care be considered early in mechanically ventilated patients with metastatic cancer.