Oncology and intensive care doctors' perception of intensive care admission of cancer patients: A cross-sectional national survey

Swarup Padhi; Prajwol Shrestha; Muhammad Alamgeer; Amanda Stevanovic; Deme Karikios; Arvind Rajamani; Ashwin Subramaniam

doi:10.1016/j.aucc.2023.12.005

Oncology and intensive care doctors' perception of intensive care admission of cancer patients: A cross-sectional national survey

Aust Crit Care. 2024 Feb 12:S1036-7314(24)00003-1. doi: 10.1016/j.aucc.2023.12.005. Online ahead of print.

Authors

Swarup Padhi¹, Prajwol Shrestha², Muhammad Alamgeer³, Amanda Stevanovic⁴, Deme Karikios⁴, Arvind Rajamani⁵, Ashwin Subramaniam⁶

Affiliations

¹ Department of Intensive Care, Goulburn Valley Health, Shepparton, Victoria, Australia. Electronic address: Swarup.padhi1983@gmail.com.
² Department of Medical Oncology, Calvary Mater Newcastle Hospital, NSW, Australia.
³ Department of Medical Oncology, Monash Health, Clayton, Victoria, Australia; School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Australia; Centre for Cancer Research, Hudson Institute of Medical Research, Clayton, Australia.
⁴ Department of Medical Oncology, Nepean Clinical School and Nepean Hospital, Kingswood, NSW, Australia; Sydney Medical School, University of Sydney, NSW, Australia.
⁵ Sydney Medical School, University of Sydney, NSW, Australia; Department of Intensive Care, Nepean Clinical School and Nepean Hospital, Kingswood, NSW, Australia.
⁶ Department of Intensive Care, Peninsula Health, Frankston, Victoria, Australia; Department of Intensive Care, Monash Health, Dandenong, Victoria, Australia; Peninsula Clinical School, Monash University, Frankston, Victoria, Australia; Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.

PMID: 38350752
DOI: 10.1016/j.aucc.2023.12.005

Abstract

Introduction: Prognosis in oncology has improved with early diagnosis and novel therapies. However, critical illness continues to trigger clinical and ethical dilemmas for the treating oncology and intensive care unit (ICU) doctors.

Objectives: The objective of this study was to investigate the perceptions of oncology and ICU doctors in managing critically ill cancer patients.

Methods: A cross-sectional web-based survey exploring the management of a fictitious acutely deteriorating case vignette with solid-organ malignancy. The survey weblink was distributed between May and July 2022 to all Australian oncology and ICU doctors via newsletters to the members of the Medical Oncology Group of Australia, the Australian and New Zealand Intensive Care Society, and the College of Intensive Care Medicine inviting them to participate. The weblink was active till August 2022. The six domains included patient prognostication, advanced care plan, collaborative management, legal/ethical/moral challenges, ICU referral, and protocol-based ICU admission. The outcomes were reported as the level of agreement between oncology and ICU doctors for each domain/question.

Results: 184 responses (64 oncology and 120 ICU doctors) were analysed. Most respondents were specialists (78.1% [n = 50] oncology, 78.3% [n = 94] ICU doctors). Oncology doctors more commonly reported managing cancer patients with poor prognosis than ICU doctors (p < 0.001). Oncology doctors less commonly referred such patients for ICU admission (29.7% [n = 19] vs. 80.8% [n = 97], p < 0.001; odds ratio [OR] = 0.07; 95% confidence interval [CI]: 0.03-0.16) and infrequently encountered patients with prior goals of care (GOC) in medical emergency team escalations (40.6% [n = 26] vs. 86.7% [n = 104]; p < 0.001; OR = 0.06; 95% CI: 0.02-0.15; p < 0.001). Oncology doctors were less likely to discuss GOC during medical emergency team calls or within 24 h of ICU admission. More oncology doctors than ICU doctors thought that training rotation in the corresponding speciality group was beneficial (56.3% [n = 36] vs. 31.7% [n = 38]; p = 0.012; OR = 2.07; 95% CI: 1.02-4.23; p = 0.045).

Conclusion: Oncology doctors were less likely to encounter acute patient deterioration or establish timely GOC for such patients. Oncology doctors believed that an ICU rotation during their training may have helped manage challenging situations.

Keywords: Advanced care planning; Goals of care; Intensive care unit admission of a cancer patient; Intensivists' perception; Oncologists' perception.