Intensive care in patients with lung cancer: a multinational study

Abstract

ICU admission was associated with meaningful survival in lung cancer patients with good PS and non-recurrent/progressive disease. Conversely, mortality rates were very high in patients not fit for anticancer treatment and poor PS. In this subgroup, palliative care may be the best option.

A bleeding problem in lung cancer patients

“…Evidently, this good performance may be due to the large experience of the team and cannot be generally extrapolated. It is important to note that in the multicentre study of ICU cancer patients by SOARES et al [8], mortality was lower in high-volume centres.…”

“…Traditionally, lung cancer patients have been considered poor candidates for intensive care unit (ICU) admission in cases of life-threatening emergencies because of a perceived dismal outcome. However, with advances in oncological and supportive therapies in lung cancer patients, including those with nonresectable non-small cell lung cancer (NSCLC), increasing numbers of them are being referred to the ICU, and their survival has been improving [7,8]. In a large, multinational study conducted in 2011, lung cancer patients accounted for 3.5% of all ICU admissions and their hospital survival was 61% [8].…”

“…However, with advances in oncological and supportive therapies in lung cancer patients, including those with nonresectable non-small cell lung cancer (NSCLC), increasing numbers of them are being referred to the ICU, and their survival has been improving [7,8]. In a large, multinational study conducted in 2011, lung cancer patients accounted for 3.5% of all ICU admissions and their hospital survival was 61% [8]. As lung cancer patients are a relatively new category of ICU patients, treatment algorithms for guidance of diagnostics and empirical therapy are in the process of development [9].…”

Has survival increased in cancer patients admitted to the ICU? No

“…For instance, patients with lung cancer still carry very high in-ICU mortality rates, especially when poor performance status, airway obstruction or extensive (non-resectable) disease are present [7]. Furthermore, the in-hospital mortality is high among ICU survivors, and maintenance of optimal treatment of lung cancer is most often jeopardized in such patients with severely impaired functional status or residual organ dysfunctions.…”

Cancer patients with ARDS: survival gains and unanswered questions

“…Survivors of ARDS thus may face ARDS-induced deterioration of quality of life superimposed upon that of the underlying malignancy. In addition, poor performance status or persisting organ functional deficits post ARDS may postpone or thwart subsequent aggressive antineoplastic therapy, and thus may prematurely end a therapeutic path which was started with initially curative intentions [13]. Finally, ICU admission, especially involving prolonged mechanical ventilation, is a particularly distressing event not only for the patient but also for the caregivers, who may experience a period of emotional roller coaster ride, owing to uncertainty about short-term survival, being followed by a prolonged period of caregiving [14].…”