Project Overview

Callum Taylor

2023-02-07

Impact of Critical Illness
on Subsequent Cancer Care and Outcomes,
in Patients With Colorectal Cancer

Why This Project?

Critical Illness Is Common In Colorectal Cancer

  • ~1/6 of Patients with Colorectal Cancer have critical care stay in first two years
  • ~Half of these patients will require a form of organ support during their stay

Why This Project?

Both Critical Illness and Colorectal Cancer Impact Survival, Physical Function, and Quality of Life

  • Short Term Survival - Most Influenced by Acute Illness Severity
  • Longer Term Survival - Most Influenced by Chronic Health and Cancer

Why This Project?

We Don’t Know: How Critical Illness affects Cancer Treatment and Outcomes

  • In a cohort of patients who all have colorectal cancer, comparing between those who do and do not experience critical illness

Proposed Study:

“Impact of Critical Illness on Subsequent Cancer Care and Outcomes, in Patients With Colorectal Cancer”

  • How does critical illness affect:
    • Your likelihood of cancer specific treatment
    • Your quality and quantity of cancer specific treatment
    • Your disease/symptom/functional outcomes

Defining Patient Population

Defining Patient Population

Domains of Study

  1. Demographics of Cohorts
  2. Quality Performance Indicators
  3. Systemic Anti-Cancer Therapy
  4. Patient Centred Outcomes

Demographics

Demographics
Age
Sex
SIMD/CARSTAIRS
Comorbidities
Frailty
Diagnosis Method

Quality Performance Indicators

QPI QPI QPI
Diagnosis/Staging Pre-Op Imaging Stoma Care
MDT Lymph Node Radiotherapy
Surgical Margins Re-Operation Dehiscence
Post Op Mortality Adjuvant Chemo Post SACT Mortality
Clinical Trials Liver Mets

Systemic Anti-Cancer Therapy

Outcome
Time To Start Systemic Anti-Cancer Therapy
Duration of Systemic Anti-Cancer Course
Presence of SACT Toxicity
Intent of SACT (Curative Vs Palliative)
Form of SACT (Regimen)

Patient Centred Outcomes

Outcome
Survival
Frailty*
Place of Death
Burden of Healthcare
Days Alive and At Home
Pain
Mental Health
Nutritional Support
Change in Accomodation

CORECT-R Dataset

Problems

  • Toxicity
  • Performance Status:
    • WoS, Grampian, Tayside, Highland
  • Frailty
    • No package of care
    • No functional assessment
    • Incomplete Performance Status

Other Aspects

  • Emergency Department Attendances
  • GP Out of Hours Use
  • Scottish Ambulance Service Use
  • NHS 24 Use

Some Results

  • Start 2006 -> End 2018

  • 38,396 Patients With Colorectal Cancer

  • 18,672 (49%) Admn To Critical Care

  • 15584 No Organ Support (Med LoS: 3 days)

  • 3088 (8%) Organ Support (Med LoS: 5 days)

    • 2376 (77%) Vasoactive Meds
    • 1448 (47%) Invasive Ventilation
    • 233 (8%) RRT

Progress

SACT Stats

Outcome Form Of Outcome Statistical Technique
Time To Start Systemic Anti-Cancer Therapy Count (Days) Negative Binomial Regression
Duration of Systemic Anti-Cancer Course Count (Days) Negative Binomial Regression
SACT Toxicity Binary Categorical Log-Binomial Regression
Intent of SACT (Curative Vs Palliative) Binary Categorical Log-Binomial Regression
Form of SACT (Regimen) Non-Ordered Categorical Multinomial Logistic Regression

Patient Centred Stats

Outcome Notes Form Of Outcome Statistical Technique
Survival Time To Event Cox Proportional Hazards Modelling
Frailty Modified Frailty Index Ordinal Categorical Multinomial Logistic Regression
Place of Death Non Ordinal Categorical Multinomial Logistic Regression
Burden of Healthcare Number of Hospital and Clinic Visits Count (Visits) Negative Binomial Regression
Days Alive and At Home Total Time Alive - Time Spent in Hospital As Inpatient Count (Days) Negative Binomial Regression
Pain Prescription data Ordinal Categorical Cumulative Linked Modelling
Mental Health Prescription data Non Ordinal Categorical Multinomial Logistic Regression
Nutritional Support Prescription data Binary Categorical Log-Binomial Regression