title: Critically ill cancer patient in intensive care unit: issues that arise.
abstract: Advances in the management of malignancies and organ failures have led to substantial increases in survival as well as in the number of cancer patients requiring intensive care unit (ICU) admission. Although effectiveness of ICU in this group remains controversial, the heterogeneity of its population in terms of the nature and curability of their disease and the severity of critical illness and underlying conditions may explain the plethora of issues arising when considering cancer patients for ICU admission, especially from the view of limited resources and ICU beds. The most frequent reasons leading a cancer patient to ICU are postoperative, respiratory failure, infection, and sepsis. Although reasons of admission, nature and number of organ failures, type of malignancy, and therapies that have preceded ICU admission may affect outcome, reliable scoring systems or survival predictors are missing. Literature suggests that organ dysfunction should be managed at its onset, whereas aggressive ICU management should be reappraised after a few days of full support. A multidisciplinary treating team of physicians should aid in changing the goals from restorative to palliative care when there appears to be no possible benefit from any treatment. End-of life-decisions and code status should be made by consensus, based on patients' autonomy and dignity. Further interventional multicenter studies are required to assess post-ICU burden, long-term medical outcomes, and quality of life in this cohort of patients.
authors.affiliation: ICU, 1st Department of Respiratory Medicine, University of Athens Medical School, "Sotiria" Hospital, 152 Mesogion Ave, GR-11527, Athens, Greece.
authors.forename: Eirini
authors.initials: E
authors.lastname: Kostakou
authors.affiliation: ICU, 1st Department of Respiratory Medicine, University of Athens Medical School, "Sotiria" Hospital, 152 Mesogion Ave, GR-11527, Athens, Greece.
authors.forename: Nikoletta
authors.initials: N
authors.lastname: Rovina
authors.affiliation: ICU, 1st Department of Respiratory Medicine, University of Athens Medical School, "Sotiria" Hospital, 152 Mesogion Ave, GR-11527, Athens, Greece.
authors.forename: Magdalini
authors.initials: M
authors.lastname: Kyriakopoulou
authors.affiliation: ICU, 1st Department of Respiratory Medicine, University of Athens Medical School, "Sotiria" Hospital, 152 Mesogion Ave, GR-11527, Athens, Greece.
authors.forename: Nikolaos G
authors.initials: NG
authors.lastname: Koulouris
authors.affiliation: ICU, 1st Department of Respiratory Medicine, University of Athens Medical School, "Sotiria" Hospital, 152 Mesogion Ave, GR-11527, Athens, Greece. Electronic address: Koutsoukou@yahoo.gr.
authors.forename: Antonia
authors.initials: A
authors.lastname: Koutsoukou
mesh_terms: D003422:Critical Care / Q000592:standards; D016638:Critical Illness; D061345:Early Medical Intervention / Q000592:standards; D019337:Hematologic Neoplasms / Q000150:complications / Q000401:mortality / Q000628:therapy; D006801:Humans; D007362:Intensive Care Units; D009369:Neoplasms / Q000150:complications / Q000401:mortality / Q000628:therapy; D063087:Noninvasive Ventilation / Q000401:mortality; D063305:Organ Dysfunction Scores; D010166:Palliative Care; D010343:Patient Admission / Q000592:standards / Q000706:statistics & numerical data; D010348:Patient Care Team / Q000458:organization & administration; D011182:Postoperative Care; D011379:Prognosis; D011788:Quality of Life; D012131:Respiratory Insufficiency / Q000628:therapy; D018805:Sepsis / Q000150:complications / Q000628:therapy; D013727:Terminal Care / Q000592:standards; D014218:Triage
keywords: Cancer patients; Critically ill; End-of-life care; Intensive care unit