Critical Care Management of Cancer Patients

Cancer patients admitted to critical care represent a growing and heterogeneous cohort, encompassing individuals with solid tumours, haematological malignancies and those undergoing advanced cellular therapies. Major complications driving intensive care unit (ICU) admission include sepsis, acute respiratory failure, tumour lysis syndrome and treatment-related toxicities such as cytokine release syndrome following adoptive immunotherapy. Survival has improved over recent decades owing to refinements in oncological regimens, early warning scores and organ-support modalities. Multidisciplinary collaboration between oncologists, haematologists, critical care physicians and specialised nurses is essential for timely triage, prognostication and delivery of tailored interventions. Risk stratification tools, including physiological scores and machine-learning algorithms, inform decisions on admission, escalation and limitations of care. Preventive bundles target ventilator-associated pneumonia, venous thromboembolism and catheter-related infections, while enhanced diagnostics guide early deployment of renal replacement therapy and vasoactive support. The balance between aggressive life-sustaining measures and integration of palliative input remains central to optimising both survival and quality of life.

Research from Nature Portfolio

A multicentre prospective study examined unplanned ICU admissions of cancer patients over a two-month interval and developed a 90-day mortality risk model. Key determinants of poorer outcome included recent antitumour treatment, transfers from non-ICU settings, high severity scores on admission, acute kidney injury and need for invasive ventilation or vasopressors. Conversely, higher body mass index and controlled hypertension emerged as protective factors. The resultant prognostic index demonstrated robust discrimination and may aid clinicians in early identification of high-risk individuals and guide discussions on the balance between invasive support and supportive care.

Critical Care Management of Cancer Patients publication trend

The graph below shows the total number of articles in critical care management of cancer patients across all publications each year (not limited to Nature Index journals).

Technical terms

Sepsis: Life-threatening organ dysfunction caused by a dysregulated host response to infection.

Acute respiratory failure: Inability of the respiratory system to maintain adequate gas exchange, often necessitating mechanical ventilation.

Tumour lysis syndrome: Metabolic derangements (hyperkalaemia, hyperuricaemia, hyperphosphataemia, hypocalcaemia) resulting from rapid tumour cell breakdown.

Cytokine release syndrome: Systemic inflammatory response characterised by fever, hypotension and organ dysfunction following immunotherapy.

APACHE score: Acute Physiology and Chronic Health Evaluation, a severity-of-illness scoring system predicting ICU mortality.

SOFA score: Sequential Organ Failure Assessment, quantifying dysfunction across respiratory, cardiovascular, hepatic, coagulation, renal and neurological systems.

Vasoactive support: Administration of drugs (e.g. norepinephrine) to maintain blood pressure in shock states.

Renal replacement therapy: Extracorporeal techniques (e.g. dialysis) to replace kidney function in acute injury.

References

1. Management of adult patients with haematological malignancies in critical care. Anaesthesia (2023).
2. Machine Learning-Based Mortality Prediction Model for Critically Ill Cancer Patients Admitted to the Intensive Care Unit (CanICU). Cancers (2023).
3. Prognostic and risk factor analysis of cancer patients after unplanned ICU admission: a real-world multicenter study. Scientific Reports (2023).