Project Overview

What happens to people with cancer, during and after their stay in critical care?

How likely is it that they get their cancer treatment?

How likely is it that they survive?

What could their survival look like?

(What might their death look like?)

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

Why Colorectal Cancer?

Scotland has the highest rate of this in the UK

It affects 1 in 20 patients in their lifetime

(It’s the dataset I have access to)

Critical Illness Is Common In Colorectal Cancer

~1/6 of Patients with Colorectal Cancer have critical care stay in first two years ¹

~Half of these patients will require a form of organ support during their stay ¹

1: Puxty 2015 JAMA Oncology

Proposed Study
How does critical illness affect:

Likelihood of cancer specific treatment (QPIs)

Quality and quantity of cancer specific treatment (SACT)

Disease/symptom/functional outcomes

CORECT-R Dataset

Thesis Chapter Outline

00a. Intro
00b. Methods
00c. Demographics of Cohorts
1. Quality Performance Indicators
1. Systemic Anti-Cancer Therapy
1. Patient Centred Outcomes
1. Conclusions

This is showing our population definition for the demographics section.

For identifying colorectal cancer, we look at SMR06
To identify cohorts, we use SMR01, inpatient stay,
You can think of them as:
Hospitalised without Critical Care
Hospitalised with Critical Care, but without Critical Illness
Hospitalised with Critical Care and Critical Illness
For each of these, we are talking about the first admission to hospital after date of cancer diagnosis
If they were diagnosed during an admission, it’s that hospital stay
Slight caveat, to catch all the instances of critical illness, if a patient was admitted to critical care in the two years after diagnosis, then the first critical care hospital stay is used rather than first hospital stay of any type

The timescale of 2006-2018 is less than the SMR06 or SMR01 range available, but is the entirety of the SICSAG dataset

Population - 43,145

2006/01–2018/12

Surgical Admissions

Planned Crit Care

Curative Intent

Demographics - Still To Do

Received an Operation
Type of Surgery
Comorbidities

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

You are less likely to get your post op adjuvant chemotherapy, if you have a critical illness requiring organ support.

Elective QPIs¹

¹: Shona MacTavish 2023

Emergency QPIs¹

¹: Shona MacTavish 2023

QPI 11¹

¹: Shona MacTavish 2023

Still To Do

Updated Cohorts
Updated Confounders Info (Comorbidities, etc)

Systemic Anti-
Cancer Therapy

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

Patient Centred

Outcome
Survival¹
~~Frailty~~ / Comorbidity
Burden of Healthcare / DAAH
Sx: Pain/Mental Health/Nutrition
Change in Accomodation
Place of Death¹

Survival, there are two different questions here, both important:

Firstly, if you are at the front door of ICU with a critical illness, what are your chances of being alive at certain points in future.
Secondly, if you survive critical illness and get out of hospital for a period of time, what are your chances now, and are they the same as those who didn’t have that experience.
First one may be useful for talking with patients at consent stage,
Second one is useful for looking at optimising cancer care

There is a difference in population being looked at for the next secion. It’s looking at those who have survived critical illness, and what there experience is following hospital. So it excludes anyone who died in their first hospital stay or in the 30 days following it.

Frailty is unfortunately not going to be answerable in the way I would like, but we will be looking at changes in Charlston scores, and Polypharmacy scores instead.

I can also look at number of hospital visits and days away from home.

As well as prescription rates of pain killers, antidepressents, and nutritional support.

I hope to look at how accomodation changes, however, that may not be possible due to numbers involved/whether data is complete enough.

Lastly we have where people are when they die.

This is a standard question asked in palliative care treatment, a large part of what’s considered a good death may weigh on where that death occurs. As such it may be important for someone to be at their own home, or often, be away from home.

This question can be asked similarly to the first outcome, survival. It can be asked prior to commencing treatment for critical illness, and it can be asked once you get through the other side.

Mandatory Degree Steps

Initial Review ✔
Annual Review ❓
- 3000 Word Report
- Presentation To Supervisor Panel
Credits: 4 (Induction, 3x Applied Stats)
Presentations: ✔
Publications: ✗

Problems

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

Other Aspects - ?Future Work

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

Demographicss

		Elective Hosp			Emergency Hosp
	No CritCare	CritCare - No Organ Support	Organ Support	No CritCare	CritCare - No Organ Support	Organ Support
N	10,023	14,523	2,643	11,061	3,541	1,354
Planned Crit Care	0	12,024	1,354	0	782	106
Surgical Admn	8,581	14,481	2,632	6,284	3,389	1,283
Curative Intent	6,104	11,965	2,124	2,600	2,061	777

//

Project Overview

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

Why Colorectal Cancer?

Critical Illness Is Common In Colorectal Cancer

Proposed Study How does critical illness affect:

CORECT-R Dataset

Thesis Chapter Outline

Population - 43,145

Surgical Admissions

Planned Crit Care

Curative Intent

Demographics - Still To Do

Quality PerformanceIndicators

Elective QPIs1

Emergency QPIs1

QPI 111

Still To Do

Systemic Anti-Cancer Therapy

Patient Centred

Mandatory Degree Steps

Problems

Other Aspects - ?Future Work

Demographicss

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

Proposed Study
How does critical illness affect:

Quality Performance
Indicators

Elective QPIs¹

Emergency QPIs¹

QPI 11¹

Systemic Anti-
Cancer Therapy