Characteristics and outcomes of patients with advanced uterine cervical cancer requiring intensive care in São Luís – Northeast Brazil
Autores: AP. Pierre de Moraes, G. Alves, JR. Lima, AA. Silva, Y. Assis, FJ. Lobato
Intensive Care Unit, Cancer Hospital of Maranhao Tarquinio Lopes Filho, São Luís, Brazil; Public health, Federal University of Maranhão, São Luís – Vila Maranhão, São Luís – State of Maranhão, Brazil, Brazil; Medicine, University CEUMA Matrix, São Luís – Vila Maranhão, São Luís – State of Maranhão, Brazil, Brazil
Correspondência: A.P. Pierre de Moraes
Intensive Care Medicine Experimental 2019, 7(Suppl 3):000559
Cervical cancer presents large geographic variations in incidence and mortality rates. Control and prevention measures also differ markedly worldwide. It is estimated that almost 90% of deaths occur in low- and middle-income countries.
To evaluate the characteristics and outcomes of cervical cancer patients requiring ICU admission and compare them to those with other solid cancer patients also requiring ICU admission.
This retrospective study was conducted at a 11-bed ICU of a public cancer hospital in São Luis, one lower income capital of northeastern Brazil. All patients > 18 years old with a solid tumor requiring ICU admission from January 2016 to December 2018 were included and were classified based on their primary solid tumor site in cervical and other solid tumor patients. We evaluated demographic and clinical variables at ICU admission, ICU support. The primary outcome were ICU and in-hospital mortality. Statistical differences were tested using Pearson´s chi-square or Mann-Whitney tests as appropriate. The significance level adopted was 0,05.
Out of 1369 patients, 148 (11%) had cervical uterine cancer and 1221 (89%) had other solid tumors. The main admission reasons were elective surgery 80 (54%), medical admission due to infection/sepsis 20 (14%) and renal disfunction 17 (12%). Compared to other solid cancer patients, cervical cancer patients were younger (p< 0,001), but did not differ in the presence of metastatical disease(p= 0,59), comorbidities (p=0,73), functional status (p=0,40), SAPS 3 score (p=0,58) and SOFA score on the first ICU day (p=0,38). Regarding ICI support, cervical cancer patients had higher need for renal
replacement therapy (p<0,001), but lower need for mechanical ventilation (p=0.01). Compared to other solid cancer patients, ICU mortality was lower in cervical cancer patients (29% versus 19%, p= 0,02), but there is no difference between groups in in-hospital mortality (40% versus 39%, p=0,69).
There was a considerable occurrence of ICU admission of young or middle-aged women with a preventable disease that had high morbidity and mortality. The results of this study reinforce the importance of providing adequate prevention programs, early diagnosis, access to medical attendance and prompt reference in order to improve cervical cancer outcomes.
1. World Heath Organization. International Agency for Research on cancer.
2. Pimple S, Mishra G, Shastri S. Global strategies for cervical cancer
prevention. Curr Opin Obstet Gynecol 2016; 28(1):4-10