Triage and Prognostication of Cancer Patients Admitted to the Intensive Care Unit

Reddy, Dereddi Raja; Botz, Gregory H.

doi:10.1016/j.ccc.2020.08.001

Cited by 15 publications

(10 citation statements)

References 88 publications

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“…However, recent improvements in cancer treatment and care that prolong life pose new challenges with respect to prognostication and treatment intensity. In previous years, very few patients with metastatic cancer would have been treated in intensive care units (ICUs), now that picture is changing [ 14 ]. There are cases where well‐founded decisions are being made to initiate intensive cancer treatment, despite patients having disseminated disease, which presuppose that the resulting adverse effects will be addressed, even where ICU treatment might be needed in selected cases.…”

Section: Palliative Oncology—a Major Part Of Oncological Treatmentmentioning

confidence: 99%

“…It should nevertheless remain the goal of health services that SPC is offered to all cancer patients on an equal basis. This is not least because SPC services can successfully manage symptoms and acute conditions [ 14 ]. These successes translate into significantly fewer emergency room visits, fewer acute admissions to hospitals, and fewer hospital deaths [ 37 , 63 ].…”

Section: Equal Access To Palliative Carementioning

confidence: 99%

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Palliative oncology and palliative care

Strang

2022

Molecular Oncology

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New therapeutic approaches can produce promising results even in severely ill cancer patients. But they also pose new challenges with respect to prognostication, as patients who were once not eligible for treatment, due to age or comorbidities, now are. Palliative oncology constitutes a major part of oncological care, with life prolongation and quality of life as its main goals. Palliative care specialists are experts in symptom control and psychosocial and existential support, and the integration of their expertise early on in patient care can prolong survival. In this article, I discuss the need to integrate specialist palliative care into early cancer treatment plans to achieve quality of life for patients. I also discuss the ways in which palliative care specialists balance the benefits of novel treatments against their adverse effects for patients, particularly for the elderly, the frail and those in advance stages of disease. I highlight the need to ensure equal access to palliative care to improve cancer patients' quality of life but also why futile, burdensome treatments should be avoided especially in the frail, elderly patients. Further, I discuss benefits and problems related to nutritional support in patients with cachexia and exemplify why translational research is needed to link basic research with clinical oncology and effective symptom control.

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Section: Palliative Oncology—a Major Part Of Oncological Treatmentmentioning

confidence: 99%

Section: Equal Access To Palliative Carementioning

confidence: 99%

Palliative oncology and palliative care

Strang

2022

Molecular Oncology

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“…After adjusting for age and APACHE II scores, the multivariate Cox analysis indicated that mechanical ventilation, enteral and parenteral nutrition signi cantly increased the risk of ICU mortality rates among terminal cancer patients. The recent review study [2] also found that invasive mechanical ventilation predicted the higher hospital mortality in cancer patients. The study [23] demonstrated the positive correlation of mechanical ventilation with mortality rates might suggest that there were the negative impacts of mechanical ventilation on barotrauma, oxygen toxicity, hemodynamic compromise, ventilatorinduced lung injury, ventilator-associated pneumonia, as well as local and systemic effects of tumor.…”

Section: Discussionmentioning

confidence: 91%

“…This review also indicated that according to the policies for ICU admission, terminal cancer patients' admission to ICU remains a controversial issue and life-sustaining treatments in ICU are not recommended for them. The recent review study [2] revealed that although cancer patients at the terminal stage might not be bene t from ICU treatments, it was not uncommon that they were admitted to ICU for end of stage organ failure. However, it is not known about their mortality rates at ICU and after ICU discharge.…”

mentioning

confidence: 99%

“…Up to date, most studies evaluated the short-term one-month and rarely, 3 to 6-month survival rates. The recent review study [2] found that ICU treatments improve the short-term outcomes among cancer patients but the ndings of the long-term mortality rates in cancer patients remain inconsistent. Moreover, there is a lack of study examining this issue among cancer patients at the end of life stage while their conditions are unlikely reversible under active treatments in ICU.…”

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confidence: 99%

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The one-year outcomes of life-sustaining treatments in intensive care units among cancer patients at the end of life stage in Taiwan: A retrospective design.

Hsiao

Lin

et al. 2021

Preprint

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Background Terminal cancer patients’ admission to intensive care unit (ICU) remains a controversial issue and there is a lack of information about their prognosis after ICU life-sustaining treatments. This one-year study aimed to compared the impacts of life-sustaining treatments and utilization of hospital care prior to ICU admission on mortality rates between cancer and non-cancer patients at the end of life stage. Methods This study adopted a one-year longitudinal retrospective design. Data from chart reviewing at the general hospital with 44 beds of ICU included the terminally ill patients’ demographic background, diseases, DNR status and life-sustaining treatments, utilization of hospital care one-year prior to ICU admission, and death at ICU and one-year post-ICU discharge. Results The higher mortality rates at ICU and one-year after ICU discharge were found in cancer group than non-cancer group (Odds ratio = 0.742; CI = 0.511–1.012, p = 0.043) (Odds ratio = 0.225; CI = 0.121–0.417, p < 0.001). Compared with non-cancer group (14%), there were lower withdrawal rates in cancer group (6.5%). No DNR designation prior to ICU admission and near half of families (49.4%) in cancer group refused to receive hospice care consultation in ICU. After adjusting for age and APACHE II scores, mechanical ventilation (Odds ratio = 2.242; CI = 1.354–4.705, p = 0.027), enteral nutrition (Odds ratio = 1.675; CI = 1.140–2.264, p = 0.004) and parenteral nutrition (Odds ratio = 1.460; CI = 0.747–2.626, p = 0.029) significantly increased the risk of ICU mortality rates among terminal cancer patients. Moreover, enteral nutrition also increased one-year mortality rates (Odds ratio = 1.558; CI = 1.112–1.985, p = 0.014). The higher usages of hospital care from general wards were found in cancer group than non-cancer group. There were no association between utilizations of hospital care and mortality rates. Conclusions Higher utilizations of hospital care and no DNR designation prior to ICU admission demonstrates the delay and barrier of Chinese patients and families’ acceptance of hospice care at the end of life stage. The higher ICU mortality rates and lower withdrawal rates urge professionals to develop cultural-sensitive family-centered hospice care program for terminal cancer patients in ICU.

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