OBJECTIVE: Sepsis is a systemic inflammatory syndrome in response to infection. Sepsis is considered severe when associated with organ dysfunction, hypoperfusion, or hypotension. Severe sepsis is considered the most common cause of death in non-coronary critical care units. The impact of severe sepsis on the oncology population has not been fully delineated. The objective of this observational study is to describe the clinical outcomes and direct medical costs of treating severe sepsis in the oncology population at a comprehensive cancer center. METHODS: A convenience sample of 20 intensive care unit patients diagnosed with severe sepsis was followed prospectively during their severe septic episode until death or hospital discharge. Clinical information was obtained from the patient medical record. Resource utilization and costs were retrieved from the institution's financial database. RESULTS: The sample was 60% male with a mean age of 63 years (27-82). The medical/surgical mix of patients was 50/50. Sixty percent of patients had solid tumors and 40% had hematological malignancies. Four patients were neutropenic on ICU admission. Eighty percent of patients had an APACHE II score ?25 on admission to the ICU. The majority of patients required vasopressor support (95%) and mechanical ventilation (85%). Eight patients (40%) required dialysis and seven patients (35%) received drotrecogin alfa. The lung was the most common presumed infection source. The mean length of stay in the ICU was 16 days (1-41). Survivors constituted 25% of the group. The top cost drivers for physician services included: 1) intensive care unit; 2) nephrology; and 3) radiology and for hospital care included: 1) room and board; 2) pharmacy; and 3) respiratory care. A detailed cost analysis is ongoing. CONCLUSION: The clinical outcomes of oncology patients who develop severe sepsis are poor despite intensive therapeutic intervention and resultant high resource utilization and costs.