Quality of life of cancer patients at 3 months after ICU stay: a prospective case-control study

Overview & Synopsis

Background: Although short and long-term survival in critically ill cancer patients has been extensively studied, limited data exist concerning their quality of life (QoL) after a stay in the intensive care unit (ICU). We sought to determine the impact of an ICU stay on QoL at 3 months in patients with solid cancer. Method: A prospective observational case-control study was conducted between February 2020 and February 2021 in three French ICUs. Surviving ICU patients with lung, colorectal, or head and neck cancer at 3 months after ICU discharge were matched with non-ICU cancer patients regarding the type of cancer, anticancer treatment goal (curative/palliative) and treatment line. QoL was assessed using the Short Form 36 (SF-36) health survey (ranging 0-100, higher values indicating better QoL) including mental (MCS) and physical (PCS) components. Anticancer treatment at 3 months was also assessed. Results: Twenty-three surviving ICU cancer patients were matched with 46 non-ICU cancer patients. All patients answered the survey except 4 patients in the ICU group. MCS was significantly higher in ICU patients than in non-ICU patients: median 54 (interquartile range [IQR] 42-57) versus 47 (IQR 37-52), respectively (P = 0.01). PCS was not different between these 2 groups: 35 (IQR 31-47) vs 42 (IQR 34-47) (P = 0.24). The multivariate analysis showed no significative association between ICU/non-ICU status of patients and the quality-of-life scores (MCS or PCS) 3 months after discharge. Therapeutic strategy at 3 months according to anticancer treatment was similar between the 2 groups. A good Performance Status (PS) (Coef 1.46, CI95% 1.11-1.90, p-value 0.01) and the non-metastatic status of the cancer (Coef 1.21, CI95% 1.05-1.40, p-value 0.01) were independently associated with a higher PCS. Conclusions: At three months, cancer patients admitted in ICU had comparable QoL to matched patients not admitted in ICU. Thus, the challenge is to identify patients with good prognostic factors who would benefit from an ICU stay in terms of QoL and continue their anticancer treatments. These results require confirmation by a multicenter study.