Critically ill patients with cancer: chances and limitations of intensive care medicine—a narrative review

Abstract

This narrative review deals with the challenge of defining adequate therapy goals and intensive care unit (ICU) admission criteria for critically ill patients with cancer. Several specific complications of critically ill patients with cancer require close collaborations of intensive care and cancer specialists. Intensivists require a basic understanding of the pathophysiology, diagnosis and therapy of common cancer-specific problems. Cancer specialists must be knowledgeable in preventing, detecting and treating imminent or manifest organ failures. In case of one or more organ dysfunctions, ICU admissions must be evaluated early. In order to properly define the therapy goals for critically ill patients with cancer, decision-makers must be aware of the short-term intensive care prognosis as well as the long-term oncological options and perspectives. Multidisciplinary teamwork is key when it comes down to decisions on ICU admission, planning of therapeutic aims, patient management in the ICU and tailored therapy limiting with smooth transition into a palliative care (PC) setting, whenever appropriate.

Characteristics and outcomes of oncology unit patients requiring admission to an Australian intensive care unit

“…Other scores have also been developed . However, regardless of the specific prognostic score used, this strengthens the evidence that the decision to admit a patient to the ICU should focus on the probability of surviving the acute illness . Medical comorbidities with ACE‐27 score also correlated with 6‐month mortality, consistent with previous studies .…”

“…Determining therapeutic goals and factors defining short‐term and long‐term prognosis necessitates multidisciplinary teamwork. The appropriate transition to terminal care with involvement of palliative care is also crucial …”

Challenging decision: ICU admission of critically ill elderly solid tumor patients

“…Introduction of smart molecules and development of new therapeutic armamentarium enabled advanced cancer patients to live longer in recent years. In accordance with these developments, intensive care unit (ICU) admissions have been steadily increasing in patients with solid tumors (2,3). Acute medical problems necessitate ICU admissions in approximately 5% of patients with solid tumors.…”

“…Delayed ICU admission is another risk factor for death in cancer patients (3,10,12,15,16). Earlier evaluation and ICU trial could save some of the critically ill cancer patients when they are in better condition with less organ failure (3,12,17,18).…”

“…Earlier evaluation and ICU trial could save some of the critically ill cancer patients when they are in better condition with less organ failure (3,12,17,18). Re-evaluation of treatment goals in days 3-5 of ICU stay may enable better prediction of individual course and outcome of critically ill cancer patients.…”