Life expectancies and prognostic factors of survival in patients with different types of cancer under prolonged mechanical ventilation: a nation-wide analysis of 5,138 cases during 1998-2007

[[abstract]]Objectives:The aim of this study was to determine survival rate, lifeexpectancy, quality-adjusted lifeexpectancy (QALE), and prognosticfactors of cancerpatients of different organ-systems undergoing prolongedmechanicalventilation (PMV). Methods: We used data from the National Health Insurance Research Database (NHIRD) of Taiwan, year of 1998 to 2007, and linked with the National Mortality Registry to ascertain the mortality. A random sample of this population was performed, and subjects who had continuously undergone mechanicalventilation for longer than 21 days were enrolled in this study. We linked our dataset with the registry of cancerunder catastrophic illnesses of NHIRD. The lifeexpectancies of different organ-systems were estimated using a semi-parametric method with assuming constant excess hazard and barrowing survival function of general population from the vital statistics of Taiwan. Multivariate proportional hazard model was constructed to assess the effect of differentprognosticfactors, including age, sex, organ-systems, comorbidities, hospital levels, and metastasis. Quality of life data were taken from a sample of 142 patientsunder PMV and measured with EQ-5D, which were classified into partial and poor cognitions. Results:The analysis of 5138 cancerpatients undergoing PMV revealed the median survival was 1.37 months with a one-year survival rate of 14.3%. Head and neck cancerpatients seemed to survive the longest. The overall lifeexpectancy was 1.21 years with estimated QALE ranged from 0.16 to 0.36 quality-adjusted life years for patients with poor and partial cognitions, respectively. Metastatic cancer status, cancertype of lung and liver significantly predict a shorter survival independently. Conclusions:Cancerpatients with PMV had a poor long term outcome. Palliative care should be considered early in these patients with such a condition, especially when metastasis occurred