Outcome for cancer patients requiring mechanical ventilation

Purpose: To describe hospital survival for cancer patients who require mech anical ventilation. Materials and Methods: A prospective, multicenter abservational study was p erformed at five academic tertiary care hospitals. Demographic and clinical variables were obtained on consecutive cancer patients at initiation of me chanical ventilation, and information on vital status at hospital discharge was acquired. Results: Our analysis was based on 782 adult cancer patients who met predet ermined inclusion criteria,The overall observed hospital mortality was 76%, with no statistically significant differences among the five study centers . Seven variables (intubation after 24 hours, leukemia, progression or recu rrence of cancer, allogeneic bone marrow transplantation, cardiac arrhythmi as, presence of disseminated intravascular coagulation, and need for vasopr essor therapy) were associated with an increased risk of death, whereas pri or surgery with curative intent was protective. The predictive model based on these variables herd an area under the receiver operating characteristic curve of 0.736, with Hosmer-Lemeshow goodness-of-fit statistics of 7.19; P = .52. Conclusion: This model can be used to estimate the probability of hospital survival for classes of adult cancer patients who require mechanical ventil ation and can help to guide physicians, patients, and families in deciding goals and direction of treatment. Prospective independent validation in dif ferent medical settings is warranted. (C) 1999 by American Society of Clini cal Oncology.