Résumé
Objective: the number of admissions of metastatic patients to intensive care units (ICU) is constantly increasing. However, admission to ICU can compromise the continuation of the oncological treatment plan. This study aims to evaluate the likelihood of resuming cancer treatment after a stay in ICU. Methods: we retrospectively analyzed data from patients at Montpellier Cancer Institute (ICM) and Gustave Roussy Institute (IGR) who were unexpectedly admited to the ICU and discharged alive. The study included patients with metastatic solid tumors admited between January 2015 and January 2023. A multivariable logistic regression model identified factors associated with treatment resumption and one-year survival. Results: of the 239 surviving patients, the median overall survival was 5.4 months [95% CI: 4.3–7.1]. Among 147 patients (61.5%) who resumed treatment, 46.3% were alive at 12 months. The most common cancers were thoracic (22.6%) and gastrointestinal (20.1%). Sepsis (40.6%) and respiratory failure (30.1%) were the leading causes of ICU admission. Key factors for treatment resumption included general condition one month before admission (p<0.001), tumor progression at admission (OR, 0.25; [95% CI: 0.10–0.63]), decisions to forgo life-sustaining therapies (OR, 0.20; [95% CI: 0.009–0.042]), and absence of organ failure support (OR, 2.24; [95% CI: 1.13–4.43]). Independent factors positively associated with 12-month survival were: resumption of anticancer treatment—whether it involved the same treatment (OR, 18.3 [95% CI: 6.17–54.27]), a reduction in the initial protocol (OR, 9.66; [95% CI: 2.88–32.33]), or a change in therapeutic line (OR, 15.59; [95% CI: 5.11–47.54])—and ICU admissions not directly related to cancer or its treatment (OR, 4.4; [95% CI: 1.56–12.41]). Conclusions: over half of metastatic patients surviving an ICU stay resumed treatment. The decision to admit metastatic patients to the ICU should carefully consider these prognostic factors.