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June 2, 1993

Critically III Cancer Patients: Benefit and Expense

JAMA. 1993;269(21):2738-2739. doi:10.1001/jama.1993.03500210038026

To the Editor.  —Schapira et al1 provided important information on the high costs per year of life gained for cancer patients who were admitted to an ICU. However, their findings leave us once again searching for a crystal ball to tell us for whom the bell will toll. The authors conclude that: "Physicians who treat patients with neoplastic disease should discuss potential outcomes and the possibility of withdrawing life-supportive therapy if appropriate with the patient and family, so that a reasonable strategy can be agreed on before the initiation of therapy." However, determining when it is appropriate to withdraw life support and what is a reasonable strategy remains a problem.The authors note that previous studies have shown that only 23.7% of cancer patients admitted to an ICU will be alive 6 months later.2 These statistics do not sound all that grim to many cancer patients who have