[Caring for The Critically Ill Cancer Patient in 2019]

Abstract

In Europe, up to 25 % of the ICU patients suffer from malignant diseases. Recent studies have shown that the short term prognosis of critically ill cancer patients is determined by the severity of the acute complication leading to ICU admission, but not by the underlying malignancy. Long-term prognosis of cancer patients surviving the ICU however is given by the underlying disease and comparable to cancer patients never admitted to the ICU. In particular, survival rates of tumor patients admitted after surgery are equal to those from surgical non-tumor patients. Despite this favorable trend the ICU admission of patients suffering from malignancy is still debatable.To define admission criteria a triage system has been developed taking into account the prognosis of the underlying disease, the overall performance status, patient will and the severity of complications. Those criteria allow us to categorize patients and to grade the intensity of treatment into "full code" treatment, a limited "ICU trial", or palliative care without ICU intervention. In addition to those, additional factors of adverse prognosis as low performance status, number of comorbidities, admission due to cardiorespiratory arrest, organ failure due to malignancy, aspergillosis or admission after allogeneic stem cell transplantation have been identified.This complexity requires an interdisciplinary cooperation between oncologists/haematologists and intensive care specialists and seems to be an essential clue to successfully manage critically ill cancer patients. For the future the improvement of education and training, the development of individualized therapies, and to seize the opportunity to use modern tools of data analytics and machine learning are important goals in this field.