Incidence,life expectancy and prognostic factors of cancer patients under prolonged mechanical ventilation: A nationwide analysis of 5,138 cases during 1998-2007

[[abstract]]INTRODUCTION: This study is aimed at determining incidence, survival rate, life expectancy, quality-adjusted life expectancy (QALE), and prognostic factors in cancer patients with different organ-systems undergoing prolonged mechanical ventilation (PMV). METHODS: We used data from the National Health Insurance Research Database (NHIRD) of Taiwan, from 1998 to 2007, linked with the National Mortality Registry to ascertain mortality. Subjects who received PMV, defined as having undergone mechanical ventilation continually for longer than 21 days, were enrolled. The incidences of cancer patients requiring PMV were calculated with the exception of multiple cancers. The life expectancies and QALE of different types of cancer were estimated. Quality of life data were taken from a sample of 142 patients under PMV. A multivariable proportional hazard model was constructed to assess the effect of different prognostic factors, including age, gender, types of cancer, metastasis, comorbidities, and hospital levels. RESULTS: Among 9011 cancer patients receiving mechanical ventilation for more than seven days, 5138 undergoing PMV revealed a median survival of 1.37 (interquartile range [IQR], 0.50-4.57) months and a one-year survival rate of 14.3% (95% confidence interval [CI], 13.3-15.3%). The incidence of PMV was 10.4 per 100 ICU admissions. Head and neck cancer patients seemed to survive the longest. The overall life expectancy was 1.21 years with estimated QALE ranging from 0.17 to 0.37 quality-adjusted life years for patients with poor and partial cognition, respectively. Cancer of liver (hazard ratio [HR], 1.55; 95%CI, 1.34-1.78), lung (HR, 1.45; 95%CI, 1.30-1.41), and metastasis (HR, 1.53; 95%CI, 1.42-1.65) independently were found to predict shorter survival. CONCLUSIONS: Cancer patients requiring PMV had poor long-term outcomes. Palliative care should be considered early in these patients, especially when metastasis has occurred