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International Transport of Critically-Ill Cancer Patients for End-Of-Life Care in Their Countries of Origin: A Retrospective Analysis
Description
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A5086 - International Transport of Critically-Ill Cancer Patients for End-Of-Life Care in Their Countries of Origin: A Retrospective Analysis
Author Block: M. Gale, N. Kostelecky, N. Halpern, L. P. Voigt; Memorial Sloan Kettering Cancer Center, New York, NY, United States.
Introduction
In this era of increasing international care, patients who are nearing end-of-life (EOL) in foreign countries may choose to travel home to die. The purpose of this study is to analyze the characteristics and challenges associated with the international air transport of critically-ill cancer patients for EOL care.
Methods
Using hospital and ICU databases, we retrospectively extracted demographic, clinical and outcome data of all terminally-ill international patients admitted to the ICU at a tertiary care cancer center from January 1, 2011 through October 10, 2017 and transported by air ambulance to their home countries for EOL care. The details and challenges of these travel arrangements were also analyzed. A waiver of authorization was obtained from the Institutional Review Board.
Results
Of 68 international cancer patients admitted to the ICU during the study period, 8 required air transportation to their home countries. Their mean age was 50 years; 6 (75%) patients were male and 5 (62%) were married, while 7 (87%) needed an interpreter. All patients (100%) had advanced stage or refractory cancers, and respiratory failure was the primary reason for ICU admission for 5 (62%). At hospital discharge, 7 patients (87%) were on narcotic medications and had various combinations of indwelling catheters (3 oral endotracheal tubes, 1 tracheostomy tube, 2 chest tubes, along with several central lines and gastro-intestinal and genitor-urinary catheters). Oxygen was supplied via mechanical ventilation for 3 (37%) patients and by nasal cannula or tracheostomy collar for 2 (25%). Vasopressor and sedative agents were used for 3 (37%) patients and 2 (25%) had a DNR order. Average flight time was 14 hours. Extensive coordination was needed between the multidisciplinary ICU team, the patients and their agents/surrogates, discharge planners, healthcare professionals in the countries of origin, localized ambulances, specialized air transport staff, embassies, and immigration services to facilitate the safe but lengthy transfer back home. No patients died during transport.
Conclusions
Successful transport by air ambulance of critically-ill patients with advanced stage or refractory cancer for EOL care in their home countries is feasible but time-consuming and multifaceted in its organizational needs. As treatment options are exhausted, critical care specialists should solicit preferences for EOL location from their patients’ or their agents/surrogates for early initiation of travel arrangements.
Author Block: M. Gale, N. Kostelecky, N. Halpern, L. P. Voigt; Memorial Sloan Kettering Cancer Center, New York, NY, United States.
Introduction
In this era of increasing international care, patients who are nearing end-of-life (EOL) in foreign countries may choose to travel home to die. The purpose of this study is to analyze the characteristics and challenges associated with the international air transport of critically-ill cancer patients for EOL care.
Methods
Using hospital and ICU databases, we retrospectively extracted demographic, clinical and outcome data of all terminally-ill international patients admitted to the ICU at a tertiary care cancer center from January 1, 2011 through October 10, 2017 and transported by air ambulance to their home countries for EOL care. The details and challenges of these travel arrangements were also analyzed. A waiver of authorization was obtained from the Institutional Review Board.
Results
Of 68 international cancer patients admitted to the ICU during the study period, 8 required air transportation to their home countries. Their mean age was 50 years; 6 (75%) patients were male and 5 (62%) were married, while 7 (87%) needed an interpreter. All patients (100%) had advanced stage or refractory cancers, and respiratory failure was the primary reason for ICU admission for 5 (62%). At hospital discharge, 7 patients (87%) were on narcotic medications and had various combinations of indwelling catheters (3 oral endotracheal tubes, 1 tracheostomy tube, 2 chest tubes, along with several central lines and gastro-intestinal and genitor-urinary catheters). Oxygen was supplied via mechanical ventilation for 3 (37%) patients and by nasal cannula or tracheostomy collar for 2 (25%). Vasopressor and sedative agents were used for 3 (37%) patients and 2 (25%) had a DNR order. Average flight time was 14 hours. Extensive coordination was needed between the multidisciplinary ICU team, the patients and their agents/surrogates, discharge planners, healthcare professionals in the countries of origin, localized ambulances, specialized air transport staff, embassies, and immigration services to facilitate the safe but lengthy transfer back home. No patients died during transport.
Conclusions
Successful transport by air ambulance of critically-ill patients with advanced stage or refractory cancer for EOL care in their home countries is feasible but time-consuming and multifaceted in its organizational needs. As treatment options are exhausted, critical care specialists should solicit preferences for EOL location from their patients’ or their agents/surrogates for early initiation of travel arrangements.
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