Long-term mortality in very old patients with cancer admitted to intensive care unit: A retrospective cohort study Antonio Paulo Nassar Junior a, ⁎, Mariane da Silva Trevisani b , Barbara Beltrame Bettim c , Pedro Caruso a,d a Intensive Care Unit, A.C. Camargo Cancer Center, São Paulo, Brazil b Research Nurse, The State of São Paulo Cancer Institute, Brazil c International Research Center, A.C. Camargo Cancer Center, São Paulo, Brazil d Discipline of Pulmonology, Heart Institute (InCor), University of São Paulo, Brazil abstract article info Article history: Received 2 January 2020 Received in revised form 23 March 2020 Accepted 3 June 2020 Available online xxxx Background: Long-term outcomes of older patients referred to intensive care unit (ICU) are of paramount impor- tance for care planning and counseling of patients and relatives. Methods: We performed a retrospective study with patients aged ≥80 years admitted to ICU from 2011 to 2017 in a cancer center. We performed two Cox proportional hazard regressions. In the first, we tested whether type of cancer (solid locoregional, solid metastatic or hematologic), Eastern Cooperative Oncology Group Performance Status (ECOG PS), and comorbidities [Charlson Comorbidity Index - CCI]) were associated with one-year mortal- ity in all patients. In the second, we assessed whether delirium, use of vasopressors, mechanical ventilation, renal replacement therapy, and forgoing life-sustaining therapies were associated with one-year mortality in survivors to hospital discharge. Results: Of 763 patients included, 482 (62.3%) patients died at one year. Metastatic cancer was significantly asso- ciated with one-year mortality (HR = 1.97; CI 95%, 1.16–3.36), but hematologic cancer, CCI and ECOG PS were not. Among patients who survived to hospital discharge, delirium, use of vasopressors, mechanical ventilation, renal replacement therapy and decisions to forgo life-sustaining therapies in ICU were not associated with one-year mortality. Conclusions: Metastatic disease at ICU admission was associated with one-year mortality in patients aged ≥80 years. Delirium, use of vasopressors, mechanical ventilation and renal replacement therapy and decisions to forgo life-sustaining therapies in ICU were not associated with one-year mortality among the patients discharged from hospital. © 2020 Elsevier Ltd. All rights reserved. Keywords: Aged 80 and over Cancer Critical care Decision making Mortality 1. Introduction Adults aged 80 years and older, also known as “very old”, are the fastest growing age group in high-income countries [1, 2]. Middle-income countries are facing an even more accelerated demo- graphic change than that faced by high-income countries and older patients now encompasses more than 10% of population in many countries [1]. Cancer risk increases with age. Although patients aged 85 years and older represent 2% of population in United States, 8% of all new cancer diagnosis came from this age group [3]. As anticancer therapies become safer and more effective, older patients have been treated more fre- quently [4]. Cancer treatment increases survival and health-related quality of life in a considerable proportion of very old patients with solid tumors [5]. In the same way, very old patients have been an increasing popula- tion in intensive care unit (ICU) and a focus of recent research [2]. It seems ICU admission is beneficial in terms of short-term mortality, al- though impact on long-term outcomes is less clear [6]. However, very old patients with cancer have encompassed only a minority of these pa- tients [7,8] or were systematically excluded of the studies [9]. Addition- ally, age and cancer are characteristics that led intensivists to consider ICU admission as non-beneficial [10–12]. Thus, the impact of very old age on critically ill patients with cancer is unknown and we believe that this knowledge is indispensable for proper ICU admission, therapeutic planning, and counseling of patients and relatives. We evaluated a cohort of very old patients with cancer ad- mitted to ICU due to unplanned reasons with two main aims. The first was to identify which factors presented at ICU admission of very old pa- tients with cancer could predict one-year mortality in all admitted Journal of Geriatric Oncology xxx (2020) xxx ⁎ Corresponding author at: Rua Professor Antonio Prudente, 211. 6th floor – Intensive Care Unit, CEP: 01509-010 São Paulo, Brazil. E-mail address: paulo.nassar@accamargo.org.br (A.P. Nassar Junior). JGO-00969; No. of pages: 6; 4C: https://doi.org/10.1016/j.jgo.2020.06.005 1879-4068/© 2020 Elsevier Ltd. All rights reserved. Contents lists available at ScienceDirect Journal of Geriatric Oncology Please cite this article as: A.P. Nassar Junior, M.S. Trevisani, B.B. Bettim, et al., Long-term mortality in very old patients with cancer admitted to intensive care unit: A retrospectiv..., J Geriatr Oncol, https://doi.org/10.1016/j.jgo.2020.06.005