Skip to main content
 

Main menu

  • Home
  • Content
    • Current Issue
    • Editor's Commentary
    • Coming Next Month
    • Archives
    • Most-Read Papers of 2021
  • Authors
    • Author Guidelines
    • Submit a Manuscript
  • Reviewers
    • Reviewer Information
    • Create Reviewer Account
    • Reviewer Guidelines: Original Research
    • Reviewer Guidelines: Reviews
    • Appreciation of Reviewers
  • CRCE
    • Through the Journal
    • JournalCasts
    • AARC University
    • PowerPoint Template
  • Open Forum
    • 2022 Call for Abstracts
    • 2021 Abstracts
    • Previous Open Forums
  • Podcast
    • English
    • Español
    • Portugûes
    • 国语
  • Videos
    • Video Abstracts
    • Author Interviews
    • Highlighted Articles
    • The Journal

User menu

  • Subscribe
  • My alerts
  • Log in

Search

  • Advanced search
American Association for Respiratory Care
  • Subscribe
  • My alerts
  • Log in
American Association for Respiratory Care

Advanced Search

  • Home
  • Content
    • Current Issue
    • Editor's Commentary
    • Coming Next Month
    • Archives
    • Most-Read Papers of 2021
  • Authors
    • Author Guidelines
    • Submit a Manuscript
  • Reviewers
    • Reviewer Information
    • Create Reviewer Account
    • Reviewer Guidelines: Original Research
    • Reviewer Guidelines: Reviews
    • Appreciation of Reviewers
  • CRCE
    • Through the Journal
    • JournalCasts
    • AARC University
    • PowerPoint Template
  • Open Forum
    • 2022 Call for Abstracts
    • 2021 Abstracts
    • Previous Open Forums
  • Podcast
    • English
    • Español
    • Portugûes
    • 国语
  • Videos
    • Video Abstracts
    • Author Interviews
    • Highlighted Articles
    • The Journal
  • Twitter
  • Facebook
  • YouTube
LetterCorrespondence

Prognosis of Cancer Patients in the ICU: Much Work Remains

François Vincent, Soufia Ayed, Abdelaziz Bouguerba, Sondes Yaacoubi and Caroline Bornstain
Respiratory Care September 2017, 62 (9) 1230-1232; DOI: https://doi.org/10.4187/respcare.05724
François Vincent
Polyvalent Intensive Care Unit Groupe Hospitalier Intercommunal Le-Raincy Montfermeil Montfermeil, France
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Soufia Ayed
Polyvalent Intensive Care Unit Groupe Hospitalier Intercommunal Le-Raincy Montfermeil Montfermeil, France
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Abdelaziz Bouguerba
Polyvalent Intensive Care Unit Groupe Hospitalier Intercommunal Le-Raincy Montfermeil Montfermeil, France
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Sondes Yaacoubi
Polyvalent Intensive Care Unit Groupe Hospitalier Intercommunal Le-Raincy Montfermeil Montfermeil, France
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Caroline Bornstain
Polyvalent Intensive Care Unit Groupe Hospitalier Intercommunal Le-Raincy Montfermeil Montfermeil, France
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • References
  • Info & Metrics
  • PDF
Loading

To the Editor:

As intensivists who are especially concerned for patients with cancer in the ICU, we have read with great interest the study by Rosa et al1 published in the May issue of the Journal. We would like to congratulate the authors for conducting this study in a tertiary referral hospital where many patients with cancer are referred and receive care daily.

The data on the results of ICU care in subjects with cancer are mostly the result of studies conducted in cancer centers or cooperative groups that are especially involved in the care of such patients, like the study group we are participating in (Groupe de Recherche en Réanimation Respiratoire en Onco-Hématologie, http://www.grrroh.com/, Accessed May 22, 2017). They are representative of selected teams and thus may only demonstrate a volume effect as previously described (eg, in some patients with cancer suffering from acute respiratory failure, septic shock, or other comorbidities).2–4 However, Soares et al5 retrospectively reviewed 9,946 subjects with cancer (solid: 8,956 [90%]; hematological: 990 [10%]) admitted to 70 ICUs (51 [72.9%] located in general hospitals and 19 [27.1%] in cancer centers) during 2013 (medical admission: 5,017 [50.4%]; urgent surgery admissions: 483 [4.9%]; elective surgery admissions: 4,446 [44.7%]). Most importantly, the authors found that ICU admissions in cancer centers were not associated with lower ICU mortality, hospital mortality, or better resource utilization when compared with ICU admissions in general hospitals. This is an argument, among others, against the establishment of specialized ICUs, at least for oncology patients, such as those admitted for management after elective surgery. This remains to be determined for hematological patients, for whom there may be a potential benefit.6

We believe that other elements need to be clarified and commented upon. The first concerns the epidemiology of patients suffering from cancer hospitalized in ICUs. The study by Taccone et al7 is dated (subjects included in the SOAP study, which collected a large amount of data on all subjects admitted to general [non-specialized] ICUs during a 2-week period [between May 1 and 15, 2002]). To the best of our knowledge, there are no data for hematological patients, except for those in the study by Taccone et al.7 Epidemiology of cancer patients is most clear for those suffering from solid tumors, especially in the study of Puxty et al8 performed in Scotland. A total of 118,541 subjects met the inclusion criteria in this study conducted between 2000 and 2009. Overall, 6,116 subjects (5.2% [95% CI 5.0–5.3%]) developed a critical illness and were admitted to the ICU within 2 y. This percentage is less than that found in a previous study in the same subjects by Bos et al9 (140,154 subjects with unplanned ICU admission between January 2007 and January 2011; solid cancers: 10.9% of all ICU subjects).

We believe that future studies must not include subjects with hematological and solid cancers together and that the term cancer patient should be abandoned. The worst in-ICU prognosis of solid cancer, except those admitted in the ICU after planned surgery, patients was demonstrated several years ago and in a large study10 of approximately 36,860 subjects with cancer. The research was conducted between 2006 and 2011 in 4 hospitals in the Netherlands linked to the Dutch National Intensive Care Evaluation registry, among whom 2,374 (6.4%) were admitted to the ICU.7,11 In this study, the long-term prognosis (evaluated after 30, 365, and 730 d of ICU admission) was better for hematological subjects. The largest study on subjects with solid cancer retrospectively analyzed the unplanned admissions of 12,290 subjects in 80 ICUs in the Netherlands over a 4-y period.9 Approximately 59.3% of all admissions were surgical (albeit unplanned), and these had a mortality rate (9.0% vs 8.9% in the ICU and 17.4% vs 14.6% in the hospital) like that of subjects with no diagnosis of cancer. In patients with solid tumors, efforts must be made to differentiate the prognosis of those admitted to the ICU after planned surgery and others (emergency surgery, medical conditions, or securing an act for diagnostic or therapeutic purposes). The distinction between the in-ICU and in-hospital prognosis between these subgroups of subjects with solid cancer was made several years ago by Soares et al.12

Management in the ICU may be very different, especially for the decision of withholding or withdrawing active therapies after an ICU trial. Recent data suggest that these decisions may be sure after 1–3 d in oncological patients, but only after 7 d in hematological ones.13 Also, Rosa et al1 do not report in their study one of the strongest determinants, which is Eastern Cooperative Oncology Group performance status, as recently confirmed, for survival in the ICU and after discharge.14,15

We fully agree with the authors that the field of research on patients with cancer admitted to ICU is still wide. Among the questions unanswered, 2 of the major elements likely to be evaluated are the possibility of reintegrating an optimal anti-neoplastic project after a stay in the ICU and the quality of life. The first element has been reported to date only in 8 studies with incomplete data, often coming from very small subtypes of subjects with cancer (Table 1). Only 2 imperfect studies report quality of life of subjects with cancers after ICU discharge.14,23 The decrease in quality of life may not be related to the fact that these patients have cancer but may simply relate to the ICU stay, as suggested in a large multi-center, prospective cohort study.24 It must finally be remembered that all of these data are valid only in developed or developing countries, where ICU beds are numerous and where the medical care of such patients is possible, mainly because the care is probably more expensive than that of other ICU patients (transfusions, antibiotics, antifungals, hematopoietic growth factors, etc.).25

View this table:
  • View inline
  • View popup
  • Download powerpoint
Table 1.

Studies Reporting Rate of Anti-Tumoral Therapies After ICU Discharge

We believe, as do Rosa et al,1 that critical care is essential in the supportive care of patients with cancer, sometimes even in those requiring palliative care.26,27 As concluded by Bos et al,11 we believe that despite the fact that 1 of 16 cancer patients was admitted to an ICU, ICU support for this group should not be considered futile. However, other studies seem necessary to better define their prognosis in the short, medium, and long term, with careful being taken to include only patients who are comparable (ie, oncology vs hematological ones, admission after planned surgery vs others) before definitive conclusions can be made.

Footnotes

  • The authors have disclosed no conflicts of interest.

  • Copyright © 2017 by Daedalus Enterprises

References

  1. 1.↵
    1. Rosa RG,
    2. Tonietto TF,
    3. Duso BA,
    4. Maccari JG,
    5. de Oliveira RP,
    6. Rutzen W,
    7. et al
    . Mortality of adult critically ill subjects with cancer. Respir Care 2017;62(5):615–622.
    OpenUrlAbstract/FREE Full Text
  2. 2.↵
    1. Zuber B,
    2. Tran TC,
    3. Aegerter P,
    4. Grimaldi D,
    5. Charpentier J,
    6. Guidet B,
    7. et al
    . Impact of case volume on survival of septic shock in patients with malignancies. Crit Care Med 2012;40(1):55–62.
    OpenUrlCrossRefPubMed
  3. 3.
    1. Lecuyer L,
    2. Chevret S,
    3. Guidet B,
    4. Aegerter P,
    5. Martel P,
    6. Schlemmer B,
    7. Azoulay E
    . Case volume and mortality in haematological patients with acute respiratory failure. Eur Respir J 2008;32(3):748–754.
    OpenUrlAbstract/FREE Full Text
  4. 4.↵
    1. Soares M,
    2. Toffart AC,
    3. Timsit JF,
    4. Burghi G,
    5. Irrázabal C,
    6. Pattison N,
    7. et al
    . Intensive care in patients with lung cancer: a multinational study. Ann Oncol 2014;25(9):1829–1835.
    OpenUrlCrossRefPubMed
  5. 5.↵
    1. Soares M,
    2. Bozza FA,
    3. Azevedo LC,
    4. Silva UV,
    5. Corrêa TD,
    6. Colombari F,
    7. et al
    . Effects of organizational characteristics on outcomes and resource use in patients with cancer admitted to intensive care units. J Clin Oncol 2016;34(27):3315–3324.
    OpenUrlAbstract/FREE Full Text
  6. 6.↵
    1. Azoulay E,
    2. Pène F,
    3. Darmon M,
    4. Lengliné E,
    5. Benoit D,
    6. Soares M,
    7. et al
    . Managing critically Ill hematology patients: time to think differently. Blood Rev 2015;29(6):359–367.
    OpenUrlCrossRefPubMed
  7. 7.↵
    1. Taccone FS,
    2. Artigas AA,
    3. Sprung CL,
    4. Moreno R,
    5. Sakr Y,
    6. Vincent JL
    . Characteristics and outcomes of cancer patients in European ICUs. Crit Care 2009;13(1):R15.
    OpenUrlCrossRefPubMed
  8. 8.↵
    1. Puxty K,
    2. McLoone P,
    3. Quasim T,
    4. Sloan B,
    5. Kinsella J,
    6. Morrison DS
    . Risk of critical illness among patients with solid cancers: a population-based observational study. JAMA Oncol 2015;1(8):1078–1085.
    OpenUrl
  9. 9.↵
    1. Bos MM,
    2. de Keizer NF,
    3. Meynaar IA,
    4. Bakhshi-Raiez F,
    5. de Jonge E
    . Outcomes of cancer patients after unplanned admission to general intensive care units. Acta Oncol 2012;51(7):897–905.
    OpenUrlCrossRefPubMed
  10. 10.↵
    1. Staudinger T,
    2. Stoiser B,
    3. Müllner M,
    4. Locker GJ,
    5. Laczika K,
    6. Knapp S,
    7. et al
    . Outcome and prognostic factors in critically ill cancer patients admitted to the intensive care unit. Crit Care Med 2000;28(5):1322–1328.
    OpenUrlCrossRefPubMed
  11. 11.↵
    1. Bos MM,
    2. Verburg IW,
    3. Dumaij I,
    4. Stouthard J,
    5. Nortier JW,
    6. Richel D,
    7. et al
    . Intensive care admission of cancer patients: a comparative analysis. Cancer Med 2015;4(7):966–976.
    OpenUrlCrossRefPubMed
  12. 12.↵
    1. Soares M,
    2. Silva UV,
    3. Teles JM,
    4. Silva E,
    5. Caruso P,
    6. Lobo SM,
    7. et al
    . Validation of four prognostic scores in patients with cancer admitted to Brazilian intensive care units: results from a prospective multicenter study. Intensive Care Med 2010;36(7):1188–1195.
    OpenUrlCrossRefPubMed
  13. 13.↵
    1. Shrime MG,
    2. Ferket BS,
    3. Scott DJ,
    4. Lee J,
    5. Barragan-Bradford D,
    6. Pollard T,
    7. et al
    . Time-limited trials of intensive care for critically ill patients with cancer: how long is long enough? JAMA Oncol 2016;2(1):76–83.
    OpenUrl
  14. 14.↵
    1. Normilio-Silva K,
    2. de Figueiredo AC,
    3. Pedroso-de-Lima AC,
    4. Tunes-da-Silva G,
    5. Nunes da Silva A,
    6. Delgado Dias Levites A,
    7. et al
    . Long-term survival, quality of life, and quality-adjusted survival in critically ill patients with cancer. Crit Care Med 2016;44(7):1327–1337.
    OpenUrl
  15. 15.↵
    1. Christodoulou C,
    2. Rizos M,
    3. Galani E,
    4. Rellos K,
    5. Skarlos DV,
    6. Michalopoulos A
    . Performance status (PS): a simple predictor of short-term outcome of cancer patients with solid tumors admitted to the intensive care unit (ICU). Anticancer Res 2007;27(4C):2945–2948.
    OpenUrlAbstract/FREE Full Text
  16. 16.
    1. Roques S,
    2. Parrot A,
    3. Lavole A,
    4. Ancel PY,
    5. Gounant V,
    6. Djibre M,
    7. Fartoukh M
    . Six-month prognosis of patients with lung cancer admitted to the intensive care unit. Intensive Care Med 2009;35(12):2044–2050.
    OpenUrlCrossRefPubMed
  17. 17.
    1. Andréjak C,
    2. Terzi N,
    3. Thielen S,
    4. Bergot E,
    5. Zalcman G,
    6. Charbonneau P,
    7. Jounieaux V
    . Admission of advanced lung cancer patients to intensive care unit: a retrospective study of 76 patients. BMC Cancer 2011;11:159.
    OpenUrlCrossRefPubMed
  18. 18.
    1. Bonomi MR,
    2. Smith CB,
    3. Mhango G,
    4. Wisnivesky JP
    . Outcomes of elderly patients with stage IIIB-IV non-small cell lung cancer admitted to the intensive care unit. Lung Cancer 2012;77(3):600–604.
    OpenUrlCrossRefPubMed
  19. 19.
    1. Kim YJ,
    2. Kim MJ,
    3. Cho YJ,
    4. Park JS,
    5. Kim JW,
    6. Chang H,
    7. et al
    . Who should be admitted to the intensive care unit? The outcome of intensive care unit admission in stage IIIB-IV lung cancer patients. Med Oncol 2014;31(3):847.
    OpenUrlCrossRefPubMed
  20. 20.
    1. Razazi K,
    2. Parrot A,
    3. Khalil A,
    4. Djibre M,
    5. Gounant V,
    6. Assouad J,
    7. et al
    . Severe haemoptysis in patients with nonsmall cell lung carcinoma. Eur Respir J 2015;45(3):756–764.
    OpenUrlAbstract/FREE Full Text
  21. 21.
    1. Camus MF,
    2. Ameye L,
    3. Berghmans T,
    4. Paesmans M,
    5. Sculier JP,
    6. Meert AP
    . Rate and patterns of ICU admission among colorectal cancer patients: a single-center experience. Support Care Cancer 2015;23(6):1779–1785.
    OpenUrl
  22. 22.
    1. Auclin E,
    2. Charles-Nelson A,
    3. Abbar B,
    4. Guérot E,
    5. Oudard S,
    6. Hauw-Berlemont C,
    7. et al
    . Outcomes in elderly patients admitted to the intensive care unit with solid tumors. Ann Intensive Care 2017;7(1):26.
    OpenUrl
  23. 23.↵
    1. Oeyen SG,
    2. Benoit DD,
    3. Annemans L,
    4. Depuydt PO,
    5. Van Belle SJ,
    6. Troisi RI,
    7. et al
    . Long-term outcomes and quality of life in critically ill patients with hematological or solid malignancies: a single center study. Intensive Care Med 2013;39(5):889–898.
    OpenUrlCrossRefPubMed
  24. 24.↵
    1. Brummel NE,
    2. Bell SP,
    3. Girard TD,
    4. Pandharipande PP,
    5. Jackson JC,
    6. Morandi A,
    7. et al
    . Frailty and subsequent disability and mortality among patients with critical illness. Am J Respir Crit Care Med 2017;196(1):64–72.
    OpenUrl
  25. 25.↵
    1. Gopal S,
    2. Wood WA,
    3. Lee SJ,
    4. Shea TC,
    5. Naresh KN,
    6. Kazembe PN,
    7. et al
    . Meeting the challenge of hematologic malignancies in sub-Saharan Africa. Blood 2012;119(22):5078–5087.
    OpenUrlAbstract/FREE Full Text
  26. 26.↵
    1. Azoulay E,
    2. Demoule A,
    3. Jaber S,
    4. Kouatchet A,
    5. Meert AP,
    6. Papazian L,
    7. Brochard L
    . Palliative noninvasive ventilation in patients with acute respiratory failure. Intensive Care Med 2011;37(8):1250–1257.
    OpenUrlCrossRefPubMed
  27. 27.↵
    1. Merceron S,
    2. Canet E,
    3. Lemiale V,
    4. Azoulay E
    . Palliative vasoactive therapy in patients with septic shock. Chest 2014;146(3):e107–e108.
    OpenUrl
PreviousNext
Back to top

In this issue

Respiratory Care: 62 (9)
Respiratory Care
Vol. 62, Issue 9
1 Sep 2017
  • Table of Contents
  • Table of Contents (PDF)
  • Cover (PDF)
  • Index by author

 

Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word on American Association for Respiratory Care.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Prognosis of Cancer Patients in the ICU: Much Work Remains
(Your Name) has sent you a message from American Association for Respiratory Care
(Your Name) thought you would like to see the American Association for Respiratory Care web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Prognosis of Cancer Patients in the ICU: Much Work Remains
François Vincent, Soufia Ayed, Abdelaziz Bouguerba, Sondes Yaacoubi, Caroline Bornstain
Respiratory Care Sep 2017, 62 (9) 1230-1232; DOI: 10.4187/respcare.05724

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero

Share
Prognosis of Cancer Patients in the ICU: Much Work Remains
François Vincent, Soufia Ayed, Abdelaziz Bouguerba, Sondes Yaacoubi, Caroline Bornstain
Respiratory Care Sep 2017, 62 (9) 1230-1232; DOI: 10.4187/respcare.05724
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Footnotes
    • References
  • Figures & Data
  • Info & Metrics
  • References
  • PDF

Related Articles

Cited By...

Info For

  • Subscribers
  • Institutions
  • Advertisers

About Us

  • About the Journal
  • Editorial Board
  • Reprints/Permissions

AARC

  • Membership
  • Meetings
  • Clinical Practice Guidelines

More

  • Contact Us
  • RSS
American Association for Respiratory Care

Print ISSN: 0020-1324        Online ISSN: 1943-3654

© Daedalus Enterprises, Inc.

Powered by HighWire