Impact of Critical Illness on Oncology Care

Chemotherapy after ICU stay

Abstract

There is a complex interplay that exists between critical care and oncology. With broadening patient eligibility criteria and increasing complexity of cancer care, an increasing proportion of oncology patients develop critical illness. We are only starting to understand the impact of an oncologic diagnosis on critical care survival. Furthermore, given improved critical care outcomes across this population, an increasingly important question surrounds how critical care survival impacts a patient’s ongoing candidacy for oncologic care. Apart from planed surgery, two situations must be individualized: patients with no indication for the continuation or initiation of treatment and patients with a formal or theoretical indication for therapy. Modification in the systemic oncology treatment plan can be explain by several factors, such as the cancerous disease itself, patient’s general status, his personal wishes and residual organ dysfunction. It is therefore essential to distinguish therapeutic impasses from more complex situations in which new anti-cancer drugs (immunotherapy, targeted therapies) could modify patients’ trajectories. The collaboration between oncologist and intensivist then holds its place, in order to better target the patients who can benefit the most from resuscitation and to implement measures that will allow them to be prepared for ICU discharge.