Author of

• 20178

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  P2.14 - Radiotherapy (ID 715)

  • Event: WCLC 2017
  • Type: Poster Session with Presenters Present
  • Track: Radiotherapy
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/17/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)

  • 23504

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    P2.14-009 - Assessing the Value of Radiotherapy for Lung Cancer in the Intensive Care Unit – A Population-based analysis (ID 9132)

    09:30 - 09:30  |  Author(s): A. Warner
    • Abstract

    Background:
    As the use of radiotherapy (RT) in lung cancer patients in the ICU is poorly described; we evaluated characteristics, outcomes, RT utilization and costs in a population-based cohort of ICU lung cancer patients in Ontario, Canada.
    
    Method:
    Eligible patients between April 1, 2007 and March 31, 2014 were identified through provincial administrative healthcare databases. Given that a patient could receive multiple RT deliveries, each ICU stay was analyzed separately as an episode of care. Significant differences in patient, treatment, institution and tumor characteristics between RT and non-RT groups were compared with t-tests and chi-square tests, as appropriate. Pre-ICU disposition was by ER admission, same institution admission or different institution transfer. The Kaplan-Meier method was used to estimate overall survival (OS), measured from index ICU admission to death, censoring at the end of the observation period. Differences in OS between the RT and non-RT groups were compared using the log-rank test. Univariable and multivariable Cox proportional hazard modeling were performed to assess the effect of RT on OS. Daily costs were calculated in 2015 Canadian dollars (converted using consumer price indices) for RT patients only, based on acute hospitalizations, ER visits, cancer clinic visits, same-day surgeries, and physician billings. For all analyses, a p-value threshold of <0.05 was used to define statistical significance.
    
    Result:
    In 13,739 unique lung cancer ICU patients, RT was delivered in 133 episodes to 1.0% (n=131) of patients. The RT group tended to be younger (median age 65 vs. 68, p<0.001), on some form of ventilation (79.8% vs. 38.2%, p<0.001) and with longer ventilation durations ((median [IQR]) 6 [1-11] vs. 0 [0-2] days, p<0.001). RT patients were more likely to present from the ER (28.2% vs. 21.9%, p=0.002) or via transfer (35.3% vs. 9.7%, p<0.001). While ICU discharge was common in both RT (56.4%) and non-RT (71.4%) cohorts, 1-year OS was poor with both groups, but most notably in the RT group (11.3% vs. 42.4%). RT was associated with inferior 1-year OS on unadjusted modeling (HR=1.99, 95% CI:1.65-2.38, p<0.001), with ventilation status and pre-ICU disposition adjusting this finding towards the null on multivariable modeling (HR=1.17, 95% CI:0.97-1.40, p=0.095). The median daily cost of medical care in RT patients was $2771 (IQR $1757-$3753), with acute hospitalization accounting for more than half (median $1723) of calculated costs.
    
    Conclusion:
    The use of RT needs to be considered judiciously for lung cancer patients in the ICU, given the poor prognosis and increased costs incurred.