Chemotherapy in the Intensive Care Unit: An Evaluation of Context and Outcomes.

BACKGROUND: Administration of chemotherapy to highly vulnerable, critically ill patients in the intensive care unit (ICU) is becoming more common, but the process requires significantly more resources than chemotherapy administration in specialized oncology settings. OBJECTIVE: To describe the context, complications, and outcomes of chemotherapy administration for cancer-related indications in ICU patients. METHODS: For this retrospective observational study, consecutive patients receiving parenteral chemotherapy in the ICU at the General Campus of The Ottawa Hospital between January 1, 2014, and December 31, 2017, were identified using pharmacy records. The clinical characteristics of these patients, details of their chemotherapy regimens, and outcomes were analyzed. RESULTS: A total of 32 patients were included in the study. Of these, 27 patients (84%) had a hematological malignancy, 16 (50%) had a documented infection at the time of chemotherapy administration, and 29 (91%) received their first cycle of chemotherapy on an urgent basis during the ICU admission rather than as a scheduled or planned treatment. Severity of illness was high both at ICU admission and at the time of chemotherapy treatment; regimen modifications, drug interactions, and adverse events were common. Remission and survival data were available for 28 patients at 12 months. Eighteen (56%) of the 32 patients survived to hospital discharge, and 12 (38%) survived to 6 months; at 12 months, survival was 25% (7 of 28 patients with available data). About one-quarter of the patients were in remission at 6 and 12 months. CONCLUSION: Administering chemotherapy in the ICU is feasible, but the process is resource-intensive. Patients with aggressive hematological cancers who require treatment on an urgent basis represent the most commonly observed scenario. This study highlights the complexity of management and the importance of multidisciplinary care teams for this patient population.

CONTEXTE: L'administration de chimiothérapie á des patients hautement vulnérables et gravement malades admis dans une unité de soins intensifs (USI) est de plus en plus courante, mais le processus exige beaucoup plus de ressources que dans des environnements spécialisés en oncologie. OBJECTIF: Décrire le contexte, les complications et les résultats de l'administration de chimiothérapie pour les indications liées au cancer de patients admis dans une USI. MÉTHODES: Les patients successifs ayant participé á cette étude observationnelle rétrospective, qui recevaient une chimiothérapie parentérale dans une USI du Campus général de l'Hôpital d'Ottawa entre le 1er janvier 2014 et le 31 décembre 2017, ont été déterminés á l'aide de dossiers de pharmacie. Les caractéristiques cliniques de ces patients, les détails de leur programme de chimiothérapie ainsi que les résultats ont fait l'objet d'une analyse. RÉSULTATS: Trente-deux (32) patients ont été inclus dans l'étude. Parmi eux, 27 (84 %) souffraient d'une hémopathie maligne, 16 (50 %) avaient une infection documentée au moment de l'administration de la chimiothérapie et 29 (91 %) recevaient en urgence le premier cycle de chimiothérapie pendant leur admission á l'USI plutôt que sous forme de traitement programmé ou planifié. Étant donné l'extrême gravité de la maladie lors de l'admission á l'USI et du traitement de chimiothérapie de ces patients, les modifications apportées au programme, les interactions médicamenteuses et les effets secondaires étaient fréquents. Les données relatives á la rémission et á la survie á 12 mois de 28 patients étaient disponibles. Le congé hospitalier a été donné á 18 (56 %) patients survivants sur les 32 admis et 12 (38 %) survivaient au 6e mois, alors qu'au 12e mois, le taux de survie était de 25 % (7 des 28 patients dont les données étaient disponibles). Environ un quart des patients étaient en rémission au 6e et au 12e mois. CONCLUSION: L'administration de chimiothérapie dans une USI est faisable, mais le processus exige beaucoup de ressources. Les patients atteints d'un cancer hématologique agressif qui ont besoin en urgence d'un traitement constituent le scénario le plus courant. Cette étude souligne la complexité de la gestion et l'importance des équipes de soins multidisciplinaires pour cette population de patients.

Adherence to guidelines and the screening tool of older persons' potentially inappropriate prescriptions criteria for colchicine dosing for gout treatment in beneficiaries of the Nova Scotia Seniors' Pharmacare Program.

PURPOSE: Colchicine is commonly used in the management of gout; however, older persons have higher risks of toxicity. Accordingly, the Screening Tool of Older Person's potentially inappropriate Prescriptions (STOPP) criteria for colchicine consider >3 months of treatment as potentially inappropriate in older persons. Recent evidence also suggests lower dosing of colchicine is as effective and results in fewer toxicities than high-dose colchicine. The objectives of this study were to determine the dose, duration, and prescribers of colchicine and to evaluate adherence to the STOPP criteria and international guidelines for colchicine in older persons. METHODS: A retrospective, observational study was conducted from April 1, 2006 to March 31, 2011 to evaluate colchicine use. Nova Scotia Seniors' Pharmacare Program beneficiaries who met inclusion criteria for an incident case of gout and who filled at least 1 prescription for colchicine during the study period were included. Colchicine dose and duration were reported descriptively. Multivariate logistic regression was used to identify predictors of the study population in making a claim for colchicine >90 and >180 days. FINDINGS: A total of 518 persons were dispensed 1327 courses of colchicine during the study period. The mean daily dose of colchicine ranged from 1.39 to 1.50 mg. Colchicine doses >1.2 mg were prescribed in approximately one-third of the study population. Colchicine was prescribed for >90 days in 14.2% of treatment courses and for >180 days in 8.1% of treatment courses. Female sex was the only predictor of treatment duration >90 days. IMPLICATIONS: This study is the first to report on colchicine dose and duration using STOPP criteria in a specific cohort of older persons with incident gout. Strategies to improve colchicine prescribing in older persons are needed.