LAUSR

We know intensive care unit (ICU) use is common among patients with cancer. Up to 5% of patients with solid tumors and 15% of those with hematologic malignancies will spend time in an ICU.1 It is certainly appropriate for a newly diagnosed person with treatable leukemia to do so, but it becomes less appropriate for someone with advanced disease whose main wish is to die at home. In the ICU, in-hospital, 3-month, and 1-year mortality rates are not much different between patients with cancer and the general population, although progressive cancer, fungal infection, and organ failure predicted worse survival.2 In this issue of JNCCN, Loh et al examined ICU admissions of patients with metastatic cancer in 2010 to determine whether inpatient palliative care (IPC) consultation had any effect on use of critical care therapies (CCTs), such as invasive mechanical ventilation, dialysis, tracheostomy, gastrostomy tube, and total parenteral nutrition. They used the California State Inpatient Databases to identify patients with metastatic cancer, and then further identified patients who used IPC by the palliative care ICD-9 diagnosis code V66.7, now Z51.5 in ICD-10-CM. Prior studies show that this method has a specificity of 95% to 99% and a sensitivity of 66% to 83%, so Loh et al may have missed about a third of the patients, but all patients with IPC consultations were included.