Outcomes of patients with small cell lung cancer admitted to the intensive care unit

e20620 Background: Small cell lung cancer (SCLC) is aggressive and carries a poor prognosis. National Comprehensive Cancer Network guidelines recommend considering systemic therapy even for patients with poor performance status, if cancer-related. However, little is known about the prognosis and effectiveness of treatment for patients with SCLC in the intensive care unit (ICU), and thus clinicians lack guidance in this scenario. Therefore, we characterized outcomes and predictors of overall survival (OS) for patients with SCLC in the ICU for cancer-related complications, with or without chemotherapy. Methods: This is a single-institution retrospective study in which we used diagnosis codes to identify all patients with SCLC who were admitted to the ICU from 2012 to 2022. We then manually selected patients admitted to the ICU for cancer-related complications and excluded those admitted for chemotherapy complications, post-operative observation, or other reasons not directly related to SCLC. Demographic and clinical data were collected via manual chart review. OS from ICU admission date was evaluated using the Kaplan-Meier method and compared between those who received chemotherapy and those who did not using the log-rank test. Multivariate analysis was performed using Cox proportional hazards regression analysis to identify predictors of OS. Sensitivity analysis was performed by excluding patients with limited stage (LS) disease. Results: Twenty-three patients met inclusion criteria, of whom 20 had extensive-stage (ES) and three had LS disease. Six patients received chemotherapy in the ICU (five with ES, one with LS) and 17 did not. Of those who received chemotherapy, two died during their stay, and four had partial responses. Median OS from ICU admission for all patients was 2.4 weeks. Median OS from ICU admission did not differ significantly between those who received chemotherapy and those who did not (21.0 vs 1.6 weeks, p = 0.12). A three-variable model significantly predicted OS: pulmonary vs non-pulmonary reason for ICU admission (HR for death = 6.18 [95% CI 2.01-19.00], p < 0.01), TNM stage IVB vs IVA or III (HR = 5.34 [1.58-18.00], p = 0.01), and Charlson Comorbidity Index (HR = 0.76 [0.56-1.04], p = 0.09). Results were similar when patients with LS disease were excluded. Conclusions: In this single-institution study of patients with SCLC admitted to the ICU for cancer-related complications, OS was short. Chemotherapy given in the ICU was not associated with longer OS. Potential clinical predictors of OS at the time of ICU admission were identified: pulmonary reason for ICU admission and TNM stage IVB were both associated with shorter OS. The trend toward improved OS associated with higher Charlson comorbidity index may reflect reversible non-malignant contributors to ICU-level illness. Conclusions apply primarily to patients with ES disease. These findings require validation in larger, multicenter studies.