Life-Supportive Therapy Withdrawal and Length of Stay in a Large Oncologic Intensive Care Unit at the End of Life

We evaluated the factors associated with life-supportive therapy withdrawal (LSTW) and length-of-stay (LOS) of adult patients with cancer who died while in the intensive care unit (ICU). We performed chart review of adult patients with cancer who died in a 53-bed ICU of a comprehensive cancer center and evaluated the relative impact of demographic and clinical factors by using logistic regression and linear regression. A total of 267 patients were included in the study. Multivariate analysis showed that white patients were 2.52 times more likely to have LSTW than patients of other ethnicities (95% confidence interval 1.23-5.15, p = 0.01). The mean LOS for patients with hematologic cancers was 7.7 days, compared to only 4.8 days for those diagnosed with nonhematologic cancers (p = 0.01). Having a hematologic cancer, LSTW, or admission into the surgical oncologic ICU independently predicted increased LOS for those who died in the ICU (p < 0.001 p = 0.001, and p < 0.001, respectively). Cultural differences in dealing with the end-of-life process rooted in religious beliefs or language barriers and reflected in the utilization rates of LSTW by non-whites and whites may partially explain our findings. The difficult transition from curative to palliative care in the ICU is reflected by the increased LOS of patients who received LSTW, were diagnosed with hematologic cancers, or were admitted into the surgical unit.