The one-year outcomes of life-sustaining treatments in intensive care units among cancer patients at the end of life stage in Taiwan: A retrospective design.

Background: Terminal cancer patients’ admission to intensive care unit (ICU) remains a controversial issue and there is a lack of information about their prognosis after ICU life-sustaining treatments. This one-year study aimed to compared the impacts of life-sustaining treatments and utilization of hospital care prior to ICU admission on mortality rates between cancer and non-cancer patients at the end of life stage. Methods This study adopted a one-year longitudinal retrospective design. Data from chart reviewing at the general hospital with 44 beds of ICU included the terminally ill patients’ demographic background, diseases, DNR status and life-sustaining treatments, utilization of hospital care one-year prior to ICU admission, and death at ICU and one-year post-ICU discharge. Results The higher mortality rates at ICU and one-year after ICU discharge were found in cancer group than non-cancer group (Odds ratio = 0.742; CI = 0.511–1.012, p  = 0.043) (Odds ratio = 0.225; CI = 0.121–0.417, p < 0.001). Compared with non-cancer group (14%), there were lower withdrawal rates in cancer group (6.5%). No DNR designation prior to ICU admission and near half of families (49.4%) in cancer group refused to receive hospice care consultation in ICU. After adjusting for age and APACHE II scores, mechanical ventilation (Odds ratio = 2.242; CI = 1.354–4.705, p  = 0.027), enteral nutrition (Odds ratio = 1.675; CI = 1.140–2.264, p  = 0.004) and parenteral nutrition (Odds ratio = 1.460; CI = 0.747–2.626, p  = 0.029) significantly increased the risk of ICU mortality rates among terminal cancer patients. Moreover, enteral nutrition also increased one-year mortality rates (Odds ratio = 1.558; CI = 1.112–1.985, p  = 0.014). The higher usages of hospital care from general wards were found in cancer group than non-cancer group. There were no association between utilizations of hospital care and mortality rates. Conclusions Higher utilizations of hospital care and no DNR designation prior to ICU admission demonstrates the delay and barrier of Chinese patients and families’ acceptance of hospice care at the end of life stage. The higher ICU mortality rates and lower withdrawal rates urge professionals to develop cultural-sensitive family-centered hospice care program for terminal cancer patients in ICU.