Intensive care unit admission for lung cancer: which patients and for which benefits?

Abstract

Lung cancer is the first cause of death from cancer. For 10 years, prognosis of lung cancer patients has improved with the development of targeted therapies, especially for adenocarcinoma. Survival of lung cancer patients admitted to the intensive care unit (ICU) is currently between 50 and 70%, with a 6-month survival of 30%. Admission to the ICU represents a major concern for the intensivist either at the time of diagnosis or during the course of the disease. Prognostic factors due to malignancy include metastatic status, performance status, malnutrition, and mutational status. Prognosticators related to the acute situation including acute respiratory failure or sepsis, and high severity score on admission also appear to be associated with mortality. However, although well established, these prognostic factors are not sufficient to make an adequate decision. The discussion about ICU admission and organ support should involve the oncologist, the intensivist, the patient, as well as his family. When prognosis is uncertain, “ICU trial” could be accepted under the condition of reappraisal of the level of care 3–5 days later. Absence of improvement in organ failure after the fifth day discriminates survivors from decedents. To date, only scarce data are available regarding quality of life and anti-cancer treatment for these patients after ICU admission.