Has survival increased in cancer patients admitted to the ICU? We are not sure

Excerpt

We are committed to providing a balanced answer on the reality of improved survival in critically ill patients with cancer. By defending the pro viewpoint, Mokart et al. [1] may be right in claiming that survival in cancer patients in general and more particularly in those with hematological malignancies has increased over the past decade. As recently reported in a prospective study including more than 1,000 hematological patients admitted to 18 ICUs from a French–Belgian network [2], overall mortality was 50 %, but more important were mortality rates in the sickest subgroups: 60 % in the case of either one vital organ failure (need for ventilation, vasopressor, or dialysis) or two vital organ failures if reversible within 7 days. Congruently to this finding, mortality rates in severe sepsis and septic shock (the most common complications in this population [3‐6]) were 34 and 46 %, respectively, approaching the figures in the non-cancer population. More recently, a large multicenter study using data from the Dutch National Intensive Care Evaluation (NICE) database published in this journal indicated that 60-day mortality in patients with hematological malignancies was similar to that in solid cancer patients and also in patients with other more classical severe comorbidities such as chronic heart failure, liver cirrhosis, and chronic pulmonary obstructive disease (COPD) [7]. In other words, triage decisions solely based on the type of underlying comorbidity is becoming obsolete. By defending the con viewpoint, Pène et al. [8] somewhat attenuates this optimism by focusing on the fact that current survival rates are still based on studies performed in heterogeneous populations coming from different centers with different experiences and cultures. Therefore, it seems naïve to recommend broad ICU admission policies or full code status for any patient with cancer and acute organ dysfunction. Strikingly, Pène et al. also shrewdly claim that for the same reasons, routine denial of cancer patients carrying one or several poor prognostic factors would be inappropriate as none of those are specific enough to predict non-beneficial care. At the end of the day, the question remains how we can move forward at the bedside to integrate these results into a genuine decision-making process so as to maintain or even improve long-term outcome in these patients without only prolonging the dying process? Indeed, the reality of physical and emotional suffering of critically ill cancer patients [9] and their relatives [10] cannot remain unrecognized. …