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Admission en réanimation pour les cancers du poumon: quels patients pour quels bénéfices ?

Intensive care unit admission for lung cancer: which patients and for which benefits?

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Réanimation

Résumé

Le cancer bronchopulmonaire (CBP) est la première cause de mortalité par cancer, tous sexes confondus. Depuis dix ans, le pronostic des patients porteurs d’un CBP, en particulier les adénocarcinomes, s’est amélioré avec le développement des thérapies ciblées. La survie des patients porteurs d’un CBP admis en réanimation est actuellement entre 50 et 70 % avec une survie à six mois de 30 %. Les patients peuvent être présentés au réanimateur lors du diagnostic ou au cours de l’évolution de la maladie tumorale. Les critères pronostiques liés à la pathologie cancéreuse sont le statut métastatique, le performance status, l’état de dénutrition et l’existence d’éventuelles mutations. Les éléments liés à la situation aiguë (admission pour insuffisance respiratoire ou sepsis, score de gravité élevé) apparaissent également associés à la mortalité. Cependant, ces éléments ne suffisent pas pour prendre la bonne décision. La discussion d’admission et de prise en charge des défaillances d’organes doit être collégiale, intégrant l’oncologue, le réanimateur, le patient et son entourage. En l’absence de certitude, une « réanimation d’attente » peut être expliquée et proposée. L’intensité des traitements doit être réévaluée après trois à cinq jours, la non-amélioration des défaillances d’organes à ce stade étant un élément pronostique discriminant. L’apport d’un séjour en réanimation sur la qualité de la vie gagnée n’a pas été suffisamment étudié.

Abstract

Lung cancer is the first cause of death from cancer. For 10 years, prognosis of lung cancer patients has improved with the development of targeted therapies, especially for adenocarcinoma. Survival of lung cancer patients admitted to the intensive care unit (ICU) is currently between 50 and 70%, with a 6-month survival of 30%. Admission to the ICU represents a major concern for the intensivist either at the time of diagnosis or during the course of the disease. Prognostic factors due to malignancy include metastatic status, performance status, malnutrition, and mutational status. Prognosticators related to the acute situation including acute respiratory failure or sepsis, and high severity score on admission also appear to be associated with mortality. However, although well established, these prognostic factors are not sufficient to make an adequate decision. The discussion about ICU admission and organ support should involve the oncologist, the intensivist, the patient, as well as his family. When prognosis is uncertain, “ICU trial” could be accepted under the condition of reappraisal of the level of care 3–5 days later. Absence of improvement in organ failure after the fifth day discriminates survivors from decedents. To date, only scarce data are available regarding quality of life and anti-cancer treatment for these patients after ICU admission.

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Authors and Affiliations

  1. Pôle cancérologie médecine aiguë et communautaire, UM oncologie thoracique, centre hospitalier universitaire A.-Michallon, BP217, F-38043, Grenoble cedex 09, France

    A. -C. Toffart, L. Sakhri & D. Moro-Sibilot

  2. Université Grenoble-I U823, institut A.-Bonniot, université J.-Fourier, Grenoble, France

    A. -C. Toffart & D. Moro-Sibilot

  3. Pôle cancérologie médecine aiguë et communautaire, UM réanimation médicale, centre hospitalier universitaire A.-Michallon, BP217, F-38043, Grenoble cedex 09, France

    L. Potton, C. Minet, C. Schwebel & J. -F. Timsit

  4. Pôle cancérologie médecine aiguë et communautaire, UM centre de coordination en cancérologie, centre hospitalier universitaire A.-Michallon, BP217, F-38043, Grenoble cedex 09, France

    P. Guillem

  5. Laboratoires des pharmaceutiques biocliniques U1039, Université J.-Fourier Grenoble-I, Grenoble, France

    C. Schwebel

Authors
  1. A. -C. Toffart
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  2. L. Sakhri
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  3. L. Potton
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  4. C. Minet
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  5. P. Guillem
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  6. C. Schwebel
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  7. D. Moro-Sibilot
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  8. J. -F. Timsit
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Correspondence to A. -C. Toffart.

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Toffart, A.C., Sakhri, L., Potton, L. et al. Admission en réanimation pour les cancers du poumon: quels patients pour quels bénéfices ?. Réanimation 22, 54–61 (2013). https://doi.org/10.1007/s13546-012-0632-4

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  • DOI: https://doi.org/10.1007/s13546-012-0632-4

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