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Background <p>Cancer is a leading cause of mortality worldwide, and a substantial proportion of patients with advanced disease require ICU admission, where decisions regarding critical care therapies are complex. Despite recommendations for early palliative care integration, its implementation in ICU settings remains limited.</p> Aim <p>To evaluate the association between palliative care involvement and the use of critical care therapies among critically ill patients with advanced solid tumors and in-hospital mortality.</p> Design <p>Multicenter retrospective cohort study.</p> Setting and participants <p>We included 292 adult patients with advanced solid tumors admitted to the ICU at three tertiary hospitals in Argentina between 2010 and 2024 who died during hospitalization. Patients were categorized according to palliative care involvement before or during ICU admission.</p> Results <p>Overall, 23% of patients (95% CI, 19–29) received palliative care, including 18% (95% CI, 13–22) prior to ICU admission. Use of critical care therapies was lower among patients receiving palliative care compared with those who did not (54% vs. 72%; <i>p</i> &lt; 0.01). After inverse probability weighting, palliative care involvement remained independently associated with lower odds of receiving critical care therapies (adjusted OR, 0.46; 95% CI, 0.33–0.66; <i>p</i> &lt; 0.01). Hospital length of stay was shorter in the palliative care group (adjusted IRR, 0.67; 95% CI, 0.57–0.78; <i>p</i> &lt; 0.01).</p> Conclusions <p>In this multicenter cohort of critically ill patients with advanced solid tumors, palliative care involvement was independently associated with reduced use of critical care therapies (including invasive mechanical ventilation, dialysis, parenteral nutrition, or tracheostomy) and shorter hospital length of stay, supporting its role in facilitating goal-concordant care.</p>

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Palliative care involvement and use of critical care therapies in patients with advanced cancer: a multicenter retrospective cohort study

  • 期刊论文

  • 发表日期：

    2026年5月23日

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  • Verónica Monzón,
  • Sabrina Di Stefano,
  • Alicia Roxana Gira,
  • Pablo Pratesi,
  • Tomás Lagos,
  • Matías Najun,
  • Melina Pochettino,
  • Bruno Leone,
  • Daniel Ivulich,
  • Hellen Huerta,
  • Luis Alberto Vélez Román,
  • Mariana Vaena,
  • Gustavo Olaizola,
  • Estefanía Bellone,
  • Álvaro Pérez de Andes,
  • Jason Nagourney,
  • Iván Huespe,
  • Susana Bauque,
  • Javier Osatnik

摘要

Background

Cancer is a leading cause of mortality worldwide, and a substantial proportion of patients with advanced disease require ICU admission, where decisions regarding critical care therapies are complex. Despite recommendations for early palliative care integration, its implementation in ICU settings remains limited.

Aim

To evaluate the association between palliative care involvement and the use of critical care therapies among critically ill patients with advanced solid tumors and in-hospital mortality.

Design

Multicenter retrospective cohort study.

Setting and participants

We included 292 adult patients with advanced solid tumors admitted to the ICU at three tertiary hospitals in Argentina between 2010 and 2024 who died during hospitalization. Patients were categorized according to palliative care involvement before or during ICU admission.

Results

Overall, 23% of patients (95% CI, 19–29) received palliative care, including 18% (95% CI, 13–22) prior to ICU admission. Use of critical care therapies was lower among patients receiving palliative care compared with those who did not (54% vs. 72%; p < 0.01). After inverse probability weighting, palliative care involvement remained independently associated with lower odds of receiving critical care therapies (adjusted OR, 0.46; 95% CI, 0.33–0.66; p < 0.01). Hospital length of stay was shorter in the palliative care group (adjusted IRR, 0.67; 95% CI, 0.57–0.78; p < 0.01).

Conclusions

In this multicenter cohort of critically ill patients with advanced solid tumors, palliative care involvement was independently associated with reduced use of critical care therapies (including invasive mechanical ventilation, dialysis, parenteral nutrition, or tracheostomy) and shorter hospital length of stay, supporting its role in facilitating goal-concordant care.