Intensivists often refuse admission to cancer patients needing critical care, which may result in denial of effective care for some deserving patients. A cancer patient may need admission to intensive care units for a variety of reasons. The outcomes of patients with hematological malignancies, previously dismal, have improved over last 10 years. The previously known indicators of poor outcome are no longer valid in view of recent advances in intensive care. A select group of patients with hematological malignancies may be offered aggressive therapy for a limited duration and then prognosis can be reassessed.
Cancer chemotherapy can produce toxicities affecting all major organ systems. Such patients may be admitted with acute organ dysfunction or years afterwards for incidental illnesses. Knowledge of these toxicities is essential for early diagnosis, management and prognostication in such patients.
The post-surgical cancer patient has unique problems, the problems of these groups are discussed. The post-surgical cancer patient may need care ranging from only monitoring; in view of supra-major surgery in some patients; to fully aggressive intensive care for post-surgical anastomotic dehiscence, mediastinitis, septic shock and multiorgan dysfunction in others. The metabolic and mechanical complications commonly seen in non-surgical cancer patients are also discussed. Intensive care should be offered to all cancer patients who have a reasonable chance of cure or palliation of their disease.
Intensive Care, mechanical ventilation, dialysis and cardiopulmoinary resuscitation: Implications for the patient with cancer. Crit Care Clin 2001;17:791-803.
Outcome of medical oncology patients in the intensive care unit. Indian J Crit Care Med 2001;5:228-33.
Intensive therapy for life-threatening medical complications of haematological malignancy. Int Care Med 1986;12:317-24
Long term prognosis and quality of life following intensive care for life-threatening complications of haematological malignancy. Br J Cancer 1991;64:938-42.
Changing use of intensive care for hematological patients: The example of multiple myeloma. Intensive Care Med 1999;25:1395-401.
Predictors of short-term mortality in critically ill patients with solid malignancies. Intensive Care Med 2000;26:1817-23.
Prognostic factors for neutropenic patients in an intensive care unit: Respective roles of underlying malignancies and acute organ failures. Eur J Cancer 1997;33:1031-7.
Outcomes of critically ill cancer patients in a university hospital setting. Am J Respir Crit Care Med 1999;160:1957-61.
Outcome and prognostic factors in critically ill cancer patients admitted to the intensive care unit. Crit Care Med 2000;28:1322-8.
Outcome and early prognostic indicators in patients with a hematologic malignancy admitted to the intensive care unit for a life-threatening complication. Crit Care Med 2003;31:104-12.
Improved survival of critically ill cancer patients with septic shock. Intensive Care Med 2003;29:1688-95.
Not-for-resuscitation orders in cancer patients-principles of decision-making. Med J Aust 1990;153:225-9.
Adriamycin cardiotoxicity: A survey of 1273 patients. Cancer Treat Rep 1979;63:827-34.
Anthracycline-induced cardiotoxicity. Ann Intern Med 1996;125:47-58.
Perioperative considerations for patients treated with bleomycin. Chest 1991;99:993-9.
The hazards of anesthesia and surgery in Bleomycin-Treated patients. Semin Oncol 1979;6:121-4.
Factors influencing postoperative morbidity and mortality in patients treated with bleomycin. Br Med J 1978;1:1664-8.
Supplemental oxygen does not cause respiratory failure in Bleomycin-treated surgical patients. Anesthesiology 1984;60:65-7.