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Should We Admit Critically Ill Cancer Patients to the ICU?

  • D. D. Benoit
  • P. O. Depuydt
  • J. M. Decruyenaere
Conference paper

Abstract

The long-term survival of patients with hematological malignancies has substantially improved over the past two decades. Nowadays, approximately 40 % of patients with acute myelogeneous leukemia or non-Hodgkin lymphoma survive for more than 5 years and it is estimated that nearly 30 % of these patients can be cured [1]. Although diseases such as multiple myeloma, low grade non-Hodgkin lymphoma and chronic lymphocytic leukemia remain incurable, half of the patients will survive for more than 4 years and survival for more than 8 to 10 years is no longer exceptional today. Similar figures can be drawn for patients with solid tumors. While the prognosis of, for instance, lung cancer and cancer of the upper gastrointestinal tract remains very grim if not detected early, substantial advances have been made in chemo-sensitive tumors such as tumors of the breast, prostate, head-and-neck region and, to a lesser extent, lower gastrointestinal tract, even in rather advanced stages of disease [1]. These improvements have been mainly achieved through the use of new and/or intensive chemotherapeutic regimens coupled with a better risk stratification of patients due to advances in radiology, immuno-histology and cytogenetics, and through advances in supportive care. Unfortunately, the therapeutic intensification coupled with longer survival time has led to an increased occurrence of potential life-threatening complications requiring intensive care unit (ICU) admission in these immunosuppressed patients [2, 3].

Keywords

Intensive Care Unit Chronic Obstructive Pulmonary Disease Renal Replacement Therapy Hematological Malignancy Intensive Care Unit Stay 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Brenner H (2002) Long-term survival rates of cancer patients achieved by the end of the 20th century: a period analysis. Lancet 360: 1131–1135CrossRefPubMedGoogle Scholar
  2. 2.
    Azoulay E, Afessa B (2006) The intensive care support for patients with malignancy._Do everything that can be done. Intensive Care Med 32: 3–5CrossRefPubMedGoogle Scholar
  3. 3.
    Pène F, Soares M (2008) Can we still refuse ICU admission of patients with hematological malignancies? Intensive Care Med 34: 847–855CrossRefGoogle Scholar
  4. 4.
    Gustafsson I, Brendorp B, Seibaek M, et al (2004) Influence of diabetes and diabetes-gender interaction on the risk of death in patients hospitalized with congestive heart failure. J Am Coll Cardiol 43: 771–777CrossRefPubMedGoogle Scholar
  5. 5.
    Mc Alister FA, Ezekowitz J, Tonelli M, et al (2004) Renal insufficiency and heart failure. Circulation 109: 1004–1009CrossRefGoogle Scholar
  6. 6.
    Schuster DP, Marion JM (1982) Precedents for meaningful recovery during treatment in a medical intensive care unit._Outcome in patients with hematologic malignancy. Am J Med 75: 402–408CrossRefGoogle Scholar
  7. 7.
    Ewer MS, Ali MK, Atta MS, Morice RC, Balakrishna PV (1986) Outcome in lung cancer patients requiring mechanical ventilation for pulmonary failure. JAMA 256: 3364–3366CrossRefPubMedGoogle Scholar
  8. 8.
    Peters SG, Meadows JA, Gracey DR (1988) Outcome of respiratory failure in hematologic malignancy. Chest 94: 99–102CrossRefPubMedGoogle Scholar
  9. 9.
    Brunet F, Lanore JJ, Dhainaut JF, et al (1990) Is intensive care justified for patients with haematological malignancies? Intensive Care Med 16: 291–297CrossRefPubMedGoogle Scholar
  10. 10.
    Sculier JP, Markiewicz E (1991) Medical cancer patients and intensive care. Anticancer Res 11: 2171–2174PubMedGoogle Scholar
  11. 11.
    Schapira DV, Studnicki J, Bradham DD, et al (1993) Intensive care, survival, and expense of treating critically ill cancer patients. JAMA 269: 783–786CrossRefPubMedGoogle Scholar
  12. 12.
    Epner DE, White P, Krasnoff M, et al (1996) Outcome of mechanical ventilation for adults with hematologic malignancy. J Invest Med 44: 254–260Google Scholar
  13. 13.
    Groeger JS, White Jr P, Nierman DM, et al (1999) Outcome for cancer patients requiring mechanical ventilation. J Clin Oncol 17: 991–997PubMedGoogle Scholar
  14. 14.
    Guiguet M, Blot F, Escudier B, et al (1998) 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? Crit Care Med 26: 488–493CrossRefPubMedGoogle Scholar
  15. 15.
    Lanore JJ, Brunet F, Pochard F, et al (1991) Hemodialysis for acute renal failure in patients with hematologic malignancies. Crit Care Med 19: 346–351CrossRefPubMedGoogle Scholar
  16. 16.
    Bach PB, Schrag D, Nieman DM, et al (2001) Identification of poor prognostic features among patients requiring mechanical ventilation after hematopoietic stem cell transplantation. Blood 98: 3234–3240CrossRefPubMedGoogle Scholar
  17. 17.
    Azoulay E, Albertti C, Bornstain C, et al (2001) Improved survival in cancer patients requiring mechanical ventilatory support: impact of noninvasive mechanical ventilatory support. Crit Care Med 29: 519–525CrossRefPubMedGoogle Scholar
  18. 18.
    Larché J, Azoulay E, Fieux F, et al (2003) Improved survival of critically ill cancer patients with septic shock. Intensive Care Med 29: 1688–1695CrossRefPubMedGoogle Scholar
  19. 19.
    Pène F, Percheron S, Lemiale V, et al (2008) Temporal changes in management and outcome of septic shock in patients with malignancies in the intensive care unit. Crit Care Med 36: 690–696CrossRefPubMedGoogle Scholar
  20. 20.
    Kress J, Christenson J, Pohlman A, et al (1999) Outcomes of critically ill cancer patients in an university hospital setting. Am J Respir Crit Care Med 160: 1957–1961PubMedGoogle Scholar
  21. 21.
    Staudinger T, Stoiser B, Müllner M, et al (2000) Outcome and prognostic factors in critically ill cancer patients admitted to the intensive care unit. Crit Care Med 28: 1322–1328CrossRefPubMedGoogle Scholar
  22. 22.
    Massion PB, Dive AL, Doyen C, et al (2002) Prognosis of hematologic malignancies does not predict intensive care unit mortality. Crit care Med 30: 2260–2270CrossRefPubMedGoogle Scholar
  23. 23.
    Benoit DD, Vandewoude KH, Decruyenaere JM, Hoste EA, Colardyn FA (2003) Outcome and early prognostic indicators in patients with a hematologic malignancy admitted to the intensive care unit for a life-threatening complication. Crit Care Med 31: 104–112CrossRefPubMedGoogle Scholar
  24. 24.
    Depuydt PO, Benoit DD, Vandewoude K, Decruyenaere J, Colardyn F (2004) Outcome in noninvasively and invasively ventilated hematologic patients with acute respiratory failure. Chest 126: 1299–1306CrossRefPubMedGoogle Scholar
  25. 25.
    Azoulay E, Thiery G, Chevret S, et al (2004) The prognosis of acute respiratory failure in critically ill cancer patients. Medicine 83: 360–370CrossRefPubMedGoogle Scholar
  26. 26.
    Soares M, Salluh JI, Spector N, Rocco JR (2005) Characteristics and outcome of cancer patients requiring mechanical ventilatory support > 24 hrs. Crit Care Med 33: 520–526CrossRefPubMedGoogle Scholar
  27. 27.
    Benoit DD, Hoste EA, Depuydt PO, et al (2005) Outcome in critically ill medical patients treated with renal replacement therapy for acute renal failure: comparison between patients with and those without haematological malignancies. Nephrol Dial Transplant 20: 552–558CrossRefPubMedGoogle Scholar
  28. 28.
    Darmon M, Thiery G, Ciroldi M, Porcher R, Sclemmer B, Azoulay E (2007) Should dialysis be offered to cancer patients with acute kidney injury? Intensive Care Med 33: 765–772CrossRefPubMedGoogle Scholar
  29. 29.
    Soares M, Salluh JI, Carvalho MS, Darmon M, Rocco JR, Spector N (2006) Prognosis of critically ill patients with cancer and acute renal dysfunction. J Clin Oncol 24: 4003–4010CrossRefPubMedGoogle Scholar
  30. 30.
    Alberti C, Brun-Buisson C, Buchardi H, et al (2002) Epidemiology of sepsis and infection in ICU patients from an international multicenter cohort study. Intensive Care Med 28: 108–121CrossRefPubMedGoogle Scholar
  31. 31.
    Price KJ, Thall PF, Kish SK, et al (1998) Prognostic indicators for blood and marrow transplant patients admitted to an intensive care unit. Am J Respir Crit Care Med 158: 876–884PubMedGoogle Scholar
  32. 32.
    Pène F, Aubron C, Azoulay E, et al (2006) Outcome of critically ill allogeneic hematopoetic stem cell transplantation recipients: a reappraisal for indications of organ failure support. J Clin Oncol 24: 643–649CrossRefPubMedGoogle Scholar
  33. 33.
    Darmon M, Thiery G, Ciroldi M, et al (2005) Intensive care in patients with newly diagnosed malignancies and a need for cancer chemotherapy. Crit Care Med 33: 2488–2493CrossRefPubMedGoogle Scholar
  34. 34.
    Benoit DD, Depuydt PO, Vandewoude KH, et al (2006) Outcome in severely ill patients with hematological malignancies who received intravenous chemotherapy in the intensive care unit. Intensive Care Med 32: 93–99CrossRefPubMedGoogle Scholar
  35. 35.
    Soares M, Salluh JI, Torres VB, Leal JV, Spector N (2008) Short-and long-term outcomes of critically ill patients with cancer and prolonged ICU length of stay. Chest 134: 520–526CrossRefPubMedGoogle Scholar
  36. 36.
    Vandijck DM, Benoit DD (2008) Impact of recent intravenous chemotherapy on outcome in severe sepsis and septic shock patients with haematological malignancies. Intensive Care Med 34: 1930–1931CrossRefGoogle Scholar
  37. 37.
    Vandijck DM, Benoit DD, Depuydt PO, et al (2008) Impact of recent intravenous chemotherapy on outcome in severe sepsis and septic shock patients with hematological malignancies. Intensive Care Med 34: 847–855CrossRefPubMedGoogle Scholar
  38. 38.
    Hilbert G, Gruson D, Vargas F, et al (2001) Noninvasive ventilation in immunosupressed patients with pulmonary infiltrates, fever, and acute respiratory failure. N Engl J Med 344: 481–487CrossRefPubMedGoogle Scholar
  39. 39.
    Antonelli M, Conti G, Bufi M, et al (2000) Nonivasive ventilation for treatment of acute respiratory failure in patients undergoing solid organ transplantation. JAMA 283: 235–241CrossRefPubMedGoogle Scholar
  40. 40.
    Keenan S, Sinuff T, Cook D, Hill NS (2004) Does noninvasive positive pressure ventilation improve outcome in acute hypoxemic failure? A systematic review. Crit Care Med 32: 2516–2523CrossRefPubMedGoogle Scholar
  41. 41.
    Gruson D, Hilbert G, Portel L, et al (1999) Severe respiratory failure requiring ICU admission in bone marrow transplant recipients. Eur Respir J 13: 883–887CrossRefPubMedGoogle Scholar
  42. 42.
    Benoit DD, Depuydt PO, Peleman RA, et al (2005) Documented and clinically suspected bacterial infection precipitating Intensive Care Unit admission in severely ill patients with hematological malignancies: impact on outcome. Intensive Care Med 31: 934–942CrossRefPubMedGoogle Scholar
  43. 43.
    Soares M, Darmon M, Salluh JI, et al (2007) Prognosis of lung cancer patients with lifethreatening complications. Chest 131: 840–846CrossRefPubMedGoogle Scholar
  44. 44.
    Schettino G, Altobelli N, Kacmarek RM (2008) Non-invasive positive-pressure ventilation in acute respiratory failure outside clinical trials: experience at the Massachusetts General Hospital. Crit Care Med 36: 441–447CrossRefPubMedGoogle Scholar
  45. 45.
    Soares M, Carvalho MS, Salluh JI, et al (2006) Effect of age on survival in critically ill patients with cancer. Crit Care Med 34: 715–721CrossRefPubMedGoogle Scholar
  46. 46.
    Thiery G, Azoulay E, Darmon M, et al (2005) Outcome of cancer patients considered for intensive care unit admission: a hospital-wide prospective study. J Clin Oncol 23: 4406–4413CrossRefPubMedGoogle Scholar
  47. 47.
    Soares M, Fontes F, Dantas J, et al (2004) Performance of six severity-of-illness scores in cancer patients requiring admission to the intensive care unit: a prospective observational study. Crit Care 8:R194–203CrossRefPubMedGoogle Scholar
  48. 48.
    Lamont EB, Christakis NA (2001) Prognostic disclosure to patients with cancer near the end of life. Ann Intern Med 134: 1096–1105PubMedGoogle Scholar
  49. 49.
    Peritti-Watel P, Bendiane MK, Pegliasco H, et al (2003) Doctor’s opinion on euthanasia, end of life care and doctor-patient communication: telephone survey in France. BMJ 327: 595–596CrossRefGoogle Scholar
  50. 50.
    Lecuyer L, Chevret S, Thiery G, Darmon M, Schlemmer B, Azoulay E (2007) The ICU trial: a new admission policy for cancer patients requiring mechanical ventilation. Crit Care Med 35: 808–814CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2009

Authors and Affiliations

  • D. D. Benoit
    • 1
  • P. O. Depuydt
    • 1
  • J. M. Decruyenaere
    • 1
  1. 1.Department of Intensive CareGhent University HospitalGhentBelgium

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