Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on sleep in brain health

LIVE: Thursday 2nd May 2024, 18:00-19:30 (CEST)

Quality sleep is essential for health. But what happens to our brains when sleep patterns are disturbed? Join our experts to explore the interplay between sleep disruption and neurological diseases, and the questions that you need to be asking your patients to help you prevent the harmful effects of sleep deprivation.
ADVANCED SEARCH
Log in
Top
BMC Cancer
Published in: BMC Cancer 1/2010

Open Access 01-12-2010 | Debate

CCC meets ICU: Redefining the role of critical care of cancer patients

Authors: Michael von Bergwelt-Baildon, Michael J Hallek, Alexander A Shimabukuro-Vornhagen, Matthias Kochanek

Published in: BMC Cancer | Issue 1/2010

Login to get access

Abstract

Background

Currently the majority of cancer patients are considered ineligible for intensive care treatment and oncologists are struggling to get their patients admitted to intensive care units. Critical care and oncology are frequently two separate worlds that communicate rarely and thus do not share novel developments in their fields. However, cancer medicine is rapidly improving and cancer is eventually becoming a chronic disease. Oncology is therefore characterized by a growing number of older and medically unfit patients that receive numerous novel drug classes with unexpected side effects.

Discussion

All of these changes will generate more medically challenging patients in acute distress that need to be considered for intensive care. An intense exchange between intensivists, oncologists, psychologists and palliative care specialists is warranted to communicate the developments in each field in order to improve triage and patient treatment. Here, we argue that "critical care of cancer patients" needs to be recognized as a medical subspecialty and that there is an urgent need to develop it systematically.

Conclusion

As prognosis of cancer improves, novel therapeutic concepts are being introduced and more and more older cancer patients receive full treatment the number of acutely ill patients is growing significantly. This development a major challenge to current concepts of intensive care and it needs to be redefined who of these patients should be treated, for how long and how intensively.
Literature
1.
Sleijfer S, Wiemer E, Verweij J: Drug Insight: gastrointestinal stromal tumors (GIST)--the solid tumor model for cancer-specific treatment. Nat Clin Pract Oncol. 2008, 5 (2): 102-111. 10.1038/ncponc1037.CrossRefPubMed
2.
Jabbour E, Cortes JE, Ghanem H, O'Brien S, Kantarjian HM: Targeted therapy in chronic myeloid leukemia. Expert review of anticancer therapy. 2008, 8 (1): 99-110. 10.1586/14737140.8.1.99.CrossRefPubMed
3.
Murdoch D, Sager J: Will targeted therapy hold its promise? An evidence-based review. Current opinion in oncology. 2008, 20 (1): 104-111. 10.1097/CCO.0b013e3282f44b12.CrossRefPubMed
4.
Brunet F, Lanore JJ, Dhainaut JF, Dreyfus F, Vaxelaire JF, Nouira S, Giraud T, Armaganidis A, Monsallier JF: Is intensive care justified for patients with haematological malignancies?. Intensive care medicine. 1990, 16 (5): 291-297. 10.1007/BF01706352.CrossRefPubMed
5.
Carlon GC: Admitting cancer patients to the intensive care unit. Critical care clinics. 1988, 4 (1): 183-191.PubMed
6.
Garrouste-Orgeas M, Boumendil A, Pateron D, Aergerter P, Somme D, Simon T, Guidet B: Selection of intensive care unit admission criteria for patients aged 80 years and over and compliance of emergency and intensive care unit physicians with the selected criteria: An observational multicenter, prospective study. Crit Care Med. 2009, 37 (11): 2919-2928. 10.1097/CCM.0b013e3181b019f0.CrossRefPubMed
7.
Sharma G, Freeman J, Zhang D, Goodwin JS: Trends in end-of-life ICU use among older adults with advanced lung cancer. Chest. 2008, 133 (1): 72-78. 10.1378/chest.07-1007.CrossRefPubMed
8.
Wolfe J, Hammel JF, Edwards KE, Duncan J, Comeau M, Breyer J, Aldridge SA, Grier HE, Berde C, Dussel V, et al: Easing of suffering in children with cancer at the end of life: is care changing?. J Clin Oncol. 2008, 26 (10): 1717-1723. 10.1200/JCO.2007.14.0277.CrossRefPubMed
9.
Blot F, Guiguet M, Nitenberg G, Leclercq B, Gachot B, Escudier B: Prognostic factors for neutropenic patients in an intensive care unit: respective roles of underlying malignancies and acute organ failures. Eur J Cancer. 1997, 33 (7): 1031-1037. 10.1016/S0959-8049(97)00042-7.CrossRefPubMed
10.
Khassawneh BY, White P, Anaissie EJ, Barlogie B, Hiller FC: Outcome from mechanical ventilation after autologous peripheral blood stem cell transplantation. Chest. 2002, 121 (1): 185-188. 10.1378/chest.121.1.185.CrossRefPubMed
11.
Massion PB, Dive AM, Doyen C, Bulpa P, Jamart J, Bosly A, Installe E: Prognosis of hematologic malignancies does not predict intensive care unit mortality. Critical care medicine. 2002, 30 (10): 2260-2270. 10.1097/00003246-200210000-00014.CrossRefPubMed
12.
Soares M, Caruso P, Silva E, Teles JM, Lobo SM, Friedman G, Dal Pizzol F, Mello PV, Bozza FA, Silva UV, et al: Characteristics and outcomes of patients with cancer requiring admission to intensive care units: a prospective multicenter study. Crit Care Med. 38 (1): 9-15. 10.1097/CCM.0b013e3181c0349e.
13.
Tamburro RF, Barfield RC, Shaffer ML, Rajasekaran S, Woodard P, Morrison RR, Howard SC, Fiser RT, Schmidt JE, Sillos EM: Changes in outcomes (1996-2004) for pediatric oncology and hematopoietic stem cell transplant patients requiring invasive mechanical ventilation. Pediatr Crit Care Med. 2008, 9 (3): 270-277. 10.1097/PCC.0b013e31816c7260.CrossRefPubMed
14.
Pene F, Percheron S, Lemiale V, Viallon V, Claessens YE, Marque S, Charpentier J, Angus DC, Cariou A, Chiche JD, et al: Temporal changes in management and outcome of septic shock in patients with malignancies in the intensive care unit. Critical care medicine. 2008, 36 (3): 690-696. 10.1097/CCM.0B013E318165314B.CrossRefPubMed
15.
Bruennler T, Mandraka F, Zierhut S, Siebig S, Wrede C, Klebl F, Holler E, Salzberger B, Schoelmerich J, Langgartner J: Outcome of hemato-oncologic patients with and without stem cell transplantation in a medical ICU. European journal of medical research. 2007, 12 (8): 323-330.PubMed
16.
Adam AK, Soubani AO: Outcome and prognostic factors of lung cancer patients admitted to the medical intensive care unit. Eur Respir J. 2008, 31 (1): 47-53. 10.1183/09031936.00031607.CrossRefPubMed
17.
Reisfield GM, Wallace SK, Munsell MF, Webb FJ, Alvarez ER, Wilson GR: Survival in cancer patients undergoing in-hospital cardiopulmonary resuscitation: a meta-analysis. Resuscitation. 2006, 71 (2): 152-160. 10.1016/j.resuscitation.2006.02.022.CrossRefPubMed
18.
Soares M, Salluh JI: Validation of the SAPS 3 admission prognostic model in patients with cancer in need of intensive care. Intensive care medicine. 2006, 32 (11): 1839-1844. 10.1007/s00134-006-0374-4.CrossRefPubMed
19.
Pene F, Soares M: Can we still refuse ICU admissionof patients with hematological malignancies?. Intensive care medicine. 2008, 34 (5): 790-792. 10.1007/s00134-008-1003-1.CrossRefPubMed
20.
Soares M, Fontes F, Dantas J, Gadelha D, Cariello P, Nardes F, Amorim C, Toscano L, Rocco JR: Performance of six severity-of-illness scores in cancer patients requiring admission to the intensive care unit: a prospective observational study. Critical care (London, England). 2004, 8 (4): R194-203. 10.1186/cc2870.CrossRef
21.
Neumann F, Lobitz O, Fenk R, Bruns I, Kostering M, Steiner S, Hennersdorf M, Kelm M, Strauer BE, Germing U, et al: The sepsis-related Organ Failure Assessment (SOFA) score is predictive for survival of patients admitted to the intensive care unit following allogeneic blood stem cell transplantation. Annals of hematology. 2008, 87 (4): 299-304. 10.1007/s00277-008-0440-9.CrossRefPubMed
22.
Schellongowski P, Benesch M, Lang T, Traunmuller F, Zauner C, Laczika K, Locker GJ, Frass M, Staudinger T: Comparison of three severity scores for critically ill cancer patients. Intensive care medicine. 2004, 30 (3): 430-436. 10.1007/s00134-003-2043-1.CrossRefPubMed
23.
Rocker G, Cook D, Sjokvist P, Weaver B, Finfer S, McDonald E, Marshall J, Kirby A, Levy M, Dodek P, et al: Clinician predictions of intensive care unit mortality. Critical care medicine. 2004, 32 (5): 1149-1154. 10.1097/01.CCM.0000126402.51524.52.CrossRefPubMed
24.
Thiery G, Azoulay E, Darmon M, Ciroldi M, De Miranda S, Levy V, Fieux F, Moreau D, Le Gall JR, Schlemmer B: Outcome of cancer patients considered for intensive care unit admission: a hospital-wide prospective study. J Clin Oncol. 2005, 23 (19): 4406-4413. 10.1200/JCO.2005.01.487.CrossRefPubMed
25.
Kalache A, Gatti A: Active ageing: a policy framework. Advances in gerontology = Uspekhi gerontologii/Rossiiskaia akademiia nauk, Gerontologicheskoe obshchestvo. 2003, 11: 7-18.PubMed
26.
Tanoue LT, Gettinger S: Treatment of lung cancer in older patients. Clinics in chest medicine. 2007, 28 (4): 735-749. 10.1016/j.ccm.2007.08.003. viCrossRefPubMed
27.
Moutouh-de Parseval LA, Weiss L, DeLap RJ, Knight RD, Zeldis JB: Tumor lysis syndrome/tumor flare reaction in lenalidomide-treated chronic lymphocytic leukemia. J Clin Oncol. 2007, 25 (31): 5047-10.1200/JCO.2007.14.2141.CrossRefPubMed
28.
St Clair EW: The calm after the cytokine storm: lessons from the TGN1412 trial. The Journal of clinical investigation. 2008, 118 (4): 1344-1347. 10.1172/JCI35382.CrossRefPubMedPubMedCentral
29.
Vahid B, Marik PE: Pulmonary complications of novel antineoplastic agents for solid tumors. Chest. 2008, 133 (2): 528-538. 10.1378/chest.07-0851.CrossRefPubMed
30.
Larche J, Azoulay E, Fieux F, Mesnard L, Moreau D, Thiery G, Darmon M, Le Gall JR, Schlemmer B: Improved survival of critically ill cancer patients with septic shock. Intensive care medicine. 2003, 29 (10): 1688-1695. 10.1007/s00134-003-1957-y.CrossRefPubMed
31.
Pene F, Aubron C, Azoulay E, Blot F, Thiery G, Raynard B, Schlemmer B, Nitenberg G, Buzyn A, Arnaud P, et al: Outcome of critically ill allogeneic hematopoietic stem-cell transplantation recipients: a reappraisal of indications for organ failure supports. J Clin Oncol. 2006, 24 (4): 643-649. 10.1200/JCO.2005.03.9073.CrossRefPubMed
32.
Soares M, Darmon M, Salluh JI, Ferreira CG, Thiery G, Schlemmer B, Spector N, Azoulay E: Prognosis of lung cancer patients with life-threatening complications. Chest. 2007, 131 (3): 840-846. 10.1378/chest.06-2244.CrossRefPubMed
33.
Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, Peterson E, Tomlanovich M: Early goal-directed therapy in the treatment of severe sepsis and septic shock. The New England journal of medicine. 2001, 345 (19): 1368-1377. 10.1056/NEJMoa010307.CrossRefPubMed
34.
Lecuyer L, Chevret S, Thiery G, Darmon M, Schlemmer B, Azoulay E: The ICU trial: a new admission policy for cancer patients requiring mechanical ventilation. Critical care medicine. 2007, 35 (3): 808-814. 10.1097/01.CCM.0000256846.27192.7A.CrossRefPubMed
35.
Guiguet M, Blot F, Escudier B, Antoun S, Leclercq B, Nitenberg G: Severity-of-illness scores for neutropenic cancer patients in an intensive care unit: Which is the best predictor? Do multiple assessment times improve the predictive value?. Critical care medicine. 1998, 26 (3): 488-493. 10.1097/00003246-199803000-00020.CrossRefPubMed
36.
Reichner CA, Thompson JA, O'Brien S, Kuru T, Anderson ED: Outcome and code status of lung cancer patients admitted to the medical ICU. Chest. 2006, 130 (3): 719-723. 10.1378/chest.130.3.719.CrossRefPubMed
37.
Schonfeld N, Timsit JF: Overcoming a stigma: the lung cancer patient in the intensive care unit. Eur Respir J. 2008, 31 (1): 3-5. 10.1183/09031936.00126307.CrossRefPubMed
Metadata
Title
CCC meets ICU: Redefining the role of critical care of cancer patients
Authors
Michael von Bergwelt-Baildon
Michael J Hallek
Alexander A Shimabukuro-Vornhagen
Matthias Kochanek
Publication date
01-12-2010
Publisher
BioMed Central
Published in
BMC Cancer / Issue 1/2010
Electronic ISSN: 1471-2407
DOI
https://doi.org/10.1186/1471-2407-10-612

Other articles of this Issue 1/2010

BMC Cancer 1/2010 Go to the issue

Research article

Dose escalation study of an anti-thrombocytopenic agent in patients with chemotherapy induced thrombocytopenia

Research article

Novel genetic variants in miR-191 gene and familial ovarian cancer

Research article

Residual hepatocellular carcinoma after oxaliplatin treatment has increased metastatic potential in a nude mouse model and is attenuated by Songyou Yin

Research article

Targeting EGFR/HER2 pathways enhances the antiproliferative effect of gemcitabine in biliary tract and gallbladder carcinomas

Research article

Expression of survivin detected by immunohistochemistry in the cytoplasm and in the nucleus is associated with prognosis of leiomyosarcoma and synovial sarcoma patients

Research article

TTFields alone and in combination with chemotherapeutic agents effectively reduce the viability of MDR cell sub-lines that over-express ABC transporters
Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras
Prof. Fabrice Barlesi
Developed by: Springer Medicine
Image Credits