Critical Care Admissions and Discharge Criteria in Cancer Patients

  • Ignacio Pujol VarelaEmail author
  • Isidro Prieto del Portillo
Reference work entry


More and more patients with solid or hematological tumors are admitted to the Intensive Care Units. The improvement in the physiopathological understanding of this group of patients, as well as the increasingly better and more targeted treatment options for their underlying disease, has led to a significant increase in their survival over the past two decades. We are living in an era in which we are defining the standards that offer the best way to care for them: From the organization and running of ICUs, the definition of clear admission criteria from the available evidence, and the development of new admission policies that expand the classic dichotomous view of whether or not they are candidates for admission to ICUs to analyzing the best treatment for them, avoiding excessive treatment, and, above all, respecting their principle of autonomy.


Oncologic patients Admission policies Multidisciplinary care Early response team Critical care transition programs Full code admission ICU trial Palliative care 


  1. 1.
    Soares M, Carusi P, Silva E, et al. Characteristics and outcomes of patients with cancer requiring admission to intensive care units: a prospective multicenter study. Crit Care Med. 2010;38(1):9–15.PubMedPubMedCentralCrossRefGoogle Scholar
  2. 2.
    Azoulay E, Alberti C, Bornstain C, et al. Improved survival in cancer patients requiring mechanical ventilation support: impact of noninvasive mechanical support. Crit Care Med. 2001;29(3):519–25.PubMedCrossRefPubMedCentralGoogle Scholar
  3. 3.
    Taccone FS, Artigas AA, Sprung CL, Moreno R, Sakr Y, Vincent JL. Characteristics and outcomes of cancer patients in European ICUs. Crit Care 2009;13(1):R15.PubMedPubMedCentralCrossRefGoogle Scholar
  4. 4.
    Puxty K, McLoone P, Quasim T, et al. Survival in solid cancer patients following intensive care unit admission. Intensive Care Med. 2014;40(10):1409–28.CrossRefGoogle Scholar
  5. 5.
    Toffart AC, Pizarro C, Schwebel C, et al. Selection criteria for intensive care unit referral of lung cancer patients: a pilot study. Eur Respir J. 2015;45:491–500.PubMedCrossRefPubMedCentralGoogle Scholar
  6. 6.
    Soares M, Bozza FA, Azevedo CP, et al. Effects of organizational characteristics on outcomes and resource use in patients with cancer admitted to intensive care units. J Clin Oncol. 2016;34:3315–24.PubMedPubMedCentralCrossRefGoogle Scholar
  7. 7.
    Carmona-Bayonas A, Gordo F, Beato C, et al. Intensive care in cancer patients in the age of immunotherapy and molecular therapies: commitment of the SEOM-SEMICYUC. Med Intensiva. 2018;42:363.PubMedCrossRefPubMedCentralGoogle Scholar
  8. 8.
    Nates JL, Nunnally M, Kleinpell R, Blosser S, Goldner J, Birriel B, Fowler CS, Byrum D, Miles WS, Bailey H, Sprung CL. ICU admission, discharge, and triage guidelines: a framework to enhance clinical operations, development of institutional policies, and further research. Crit Care Med. 2016;44(8):1553–602.CrossRefGoogle Scholar
  9. 9.
    Soubani O. Critical care prognosis and outcomes in patients with cancer. Clin Chest Med. 2017;38(2):333–353.PubMedCrossRefPubMedCentralGoogle Scholar
  10. 10.
    Pinsky MR, Brochard L, Kellum JA. Ten recent advances that could not have come about without applying physiology. Intensive Care Med. 2015. Online print 25th March.PubMedCrossRefPubMedCentralGoogle Scholar
  11. 11.
    Azoulay E, Pene F, Darmon M, et al. Managing critically ill hematology patients: time to think differently. Blood Rev. 2015;29(6):359–67.PubMedCrossRefPubMedCentralGoogle Scholar
  12. 12.
    Sbrana A, Torchio M, Comolli G, et al. Use of procalcitonin in clinical oncology: a literature review. New Microbiol. 2016;39(3):174–80.PubMedPubMedCentralGoogle Scholar
  13. 13.
    Miller KD, Siegel RL, Lin CC, et al. Cancer treatment and survivorship statistics. CA Cancer J Clin. 2016;66: 271–89.CrossRefGoogle Scholar
  14. 14.
    Teno JM, Gozalo PL, Bynum J, et al. Change in end-of-life care for Medicare beneficiaries: site of dead, place of care, and health care transitions in 2000, 2005 and 2009. JAMA. 2009;309(5):470–7.CrossRefGoogle Scholar
  15. 15.
    Benoit DD, Soares M, Azoulay E. Has survival increased in cancer patients admitted to the ICU? We are not sure. Intensive Care Med. 2014;40(10):1576–9.PubMedCrossRefPubMedCentralGoogle Scholar
  16. 16.
    Soubani AO, Decruyenaere J. Improved outcome of critically ill patients with hematological malignancies: what is next? Intensive Care Med. 2014;40(9):1377–8.PubMedCrossRefPubMedCentralGoogle Scholar
  17. 17.
    Nasir SS, Muthiad M, Ryder K, et al. ICU deaths in patients with advanced cancer: reasonable criteria to decrease potentially inappropriate admissions and lack of benefit of advance planning discussions. Am J Hosp Palliat Med. 2017;34(2):173–179.CrossRefGoogle Scholar
  18. 18.
    Suh GY, Ryu JA, Chung CR, et al. Effect of early intervention on long term outcomes of critically ill cancer patients admitted to ICUs. Crit Care Med. 2015;43(7):1439–48.PubMedCrossRefPubMedCentralGoogle Scholar
  19. 19.
    Azoulay E, Mokart D, Péne E, et al. Outcomes of critically ill patients with hematological malignances prospective multicenter data from France and Belgium. J Clin Oncol. 2013;31(22):2810–8.CrossRefGoogle Scholar
  20. 20.
    de Monmollin E, Tandjaoui-Lambiotte Y, Legrand M, et al. Outcome in critically ill cancer patients with septic shock of pulmonary origin. Shock. 2013;39(3): 250–4.CrossRefGoogle Scholar
  21. 21.
    Thiery G, Azoulay E, Darmon M, et al. Outcome of cancer patients considered for intensive care unit admission: a hospital-wide prospective study. J Clin Oncol. 2005;23(19):4406–13.PubMedCrossRefPubMedCentralGoogle Scholar
  22. 22.
    Auclin E, Charles-Nelson A, Abbar B, et al. Outcomes in elderly patients admitted to the intensive care unit with solid tumors. Ann Intensive Care. 2017;7:26.PubMedPubMedCentralCrossRefGoogle Scholar
  23. 23.
    Bouteloup M, Perinel S, Bourmaud A, et al. Outcomes in adult critically ill cancer patients with and without neutropenia: a systematic review and meta-analysis of the Groupe de Recherche en Réanimation Respiratoire du patient d’Onco-Hématologie (GRRR-OH). Oncotarget. 2017;8(1):1860–70.CrossRefGoogle Scholar
  24. 24.
    Al-Zubaidi N, Soubani AO. Predictors of mortality in patients with hematologic malignancies admitted to the ICU- a prospective observational study. Am J Respir Crit Care Med. 2016;193:A3657.Google Scholar
  25. 25.
    Soares M, Fontes F, Dantas J, et al. Performance of six severity-of-illness scores in cancer patients requiring admission to the intensive care unit: a prospective observational study. Crit Care Med. 2004;8(4):R194–203.Google Scholar
  26. 26.
    Bayraktar UD, Shpall EJ, Liu P, et al. Hematopoietic cell transplantation specific comorbidity index predicts inpatient mortality and survival in patients who received allogeneic transplantation admitted to the intensive care unit. J Clin Oncol. 2013;31(33): 4207–14.PubMedPubMedCentralCrossRefGoogle Scholar
  27. 27.
    Cárdenas-Turanzas M, Ensor J, Wakefield C, et al. Cross-validation of a Sequential Organ Failure Assessment score-based model to predict mortality in patients with cancer admitted to the intensive care unit. J Crit Care. 2012;27(6):673–80.CrossRefGoogle Scholar
  28. 28.
    Aygencel G, Turkoglu M, Turkoz Sucak G, et al. Prognostic factors in critically ill cancer patients admitted to the intensive care unit. J Crit Care. 2014;29:618–26.PubMedCrossRefPubMedCentralGoogle Scholar
  29. 29.
    Prendergast TJ, Luce JM. Increasing incidence of withholding and withdrawal of life support from the critically ill. Am J Respir Crit Care Med. 1997;155(1): 15–20.PubMedCrossRefPubMedCentralGoogle Scholar
  30. 30.
    Kostakou E, Rovina N, Kyriakopoulou M, et al. Critically ill cancer patient in intensive care unit: issues that arise. J Crit Care. 2014;29:817–22.PubMedCrossRefPubMedCentralGoogle Scholar
  31. 31.
    Keating NL, Landrum MB, Rogers SO, et al. Physician factors associated with discussions about end-of-life care. Cancer. 2010;116(4):998–1006.PubMedPubMedCentralCrossRefGoogle Scholar
  32. 32.
    Afessa B, Azoulay E. Critical care of the hematopoietic stern cell transplant recipient. Crit Care Med. 2010; 26(1):133–50.Google Scholar
  33. 33.
    Mendoza V, Lee A, Mark PE. The hospital survival and prognostic factors of patients with solid tumors admitted to an ICU. Am J Hosp Palliat Care. 2008;25:240–3.PubMedCrossRefPubMedCentralGoogle Scholar
  34. 34.
    Soares M, Salluh JL, Spector N, Rocco JR. Characteristics and outcomes of cancer patients requiring mechanical ventilatory support for >24 hrs. Crit Care Med. 2005;33:520–6.PubMedCrossRefPubMedCentralGoogle Scholar
  35. 35.
    Maccariello E, Valente C, Nogueira L, et al. Outcomes of cancer and non-cancer patients with acute kidney injury and need of renal replacement therapy admitted to general intensive care units. Nephrol Dial Transplant. 2011;26:537–43.PubMedCrossRefPubMedCentralGoogle Scholar
  36. 36.
    Benoit DD, Vandewoude KH, Decruyenaere JM, et al. Outcome and early prognostic indicators in patients with a hematologic malignancy admitted to the ICU for a life-threatening complication. Crit Care Med. 2003;31(1):104–12.CrossRefGoogle Scholar
  37. 37.
    Shimabukuro-Vornhagen A, Boll B, Kochanek M, et al. Critical care of patients with cancer. CA Cancer J Clin. 2016;66:496–517.PubMedPubMedCentralCrossRefGoogle Scholar
  38. 38.
    Frat JP, Thile AW, Mercat A, et al. High flow oxygen through nasal cannula in acute hypoxemic respiratory failure. N Engl J Med. 2015;372:2186–96.CrossRefGoogle Scholar
  39. 39.
    Mokart D, Geay C, Chow-Chine L, et al. High flow oxygen therapy in cancer patients with acute respiratory failure. Intensive Care Med. 2015;41:2008–10.PubMedCrossRefPubMedCentralGoogle Scholar
  40. 40.
    de Almeida JP, Vincent JL, Galas FR, et al. Transfusion requirements in surgical oncology patients: a prospective randomized controlled trial. Anesthesiology. 2015; 122:29–38.PubMedCrossRefPubMedCentralGoogle Scholar
  41. 41.
    Azoulay E, Schellongowski P, Darmon M, et al. The Intensive Care Medicine research agenda on critically ill oncology and hematology patients. Intensive Care Med. 2017;43:1366–82.PubMedCrossRefPubMedCentralGoogle Scholar
  42. 42.
    Lecuyer L, Chevret S, Guidet B, et al. The ICU trial: a new admission policy for cancer patients requiring mechanical ventilation. Crit Care Med. 2007;35(3): 808–14.PubMedCrossRefPubMedCentralGoogle Scholar
  43. 43.
    Azoulay E, Afessa B. The intensive care support of patients with malignance: do everything that can be done. Intensive Care Med. 2006;32:3–5.PubMedCrossRefPubMedCentralGoogle Scholar
  44. 44.
    Suhag V, Sunita BS, Sarin A, et al. Intensive care for cancer patients, an overview. Asian Australas J Anim. 2014;13:193–201.Google Scholar
  45. 45.
    Shrime MG, Ferket BS, Scott DJ, et al. Time-limited trials of intensive care for critically ill patients with cancer: how long is long enough? JAMA Oncol. 2016;2:76–83.PubMedPubMedCentralCrossRefGoogle Scholar
  46. 46.
    Hosein FS, Roberts DJ, Turin TC, et al. A meta-analysis to derive literature-based benchmarks for readmission and hospital mortality after patient discharge from intensive care. Crit Care. 2014;18(6):715.PubMedPubMedCentralCrossRefGoogle Scholar
  47. 47.
    Stelfox HT, Bastos J, Niven DJ, et al. Critical care transition programs and the risk of readmission or death after discharge from ICU. Intensive Care Med. 2016;42(3):401–10.PubMedCrossRefPubMedCentralGoogle Scholar
  48. 48.
    Staudinger T, Stoiser B, Mullner M, et al. Outcome and prognostic factors in critically ill cancer patients admitted to the intensive care unit. Crit Care Med. 2000;28:1322–1328.PubMedCrossRefPubMedCentralGoogle Scholar
  49. 49.
    Wohlfarth P, Staudinger T, Sperr W, et al. Prognostic factors, long term survival, and outcome of cancer patients receiving chemotherapy. Ann Hematol. 2014;93:1629–1636.PubMedCrossRefPubMedCentralGoogle Scholar
  50. 50.
    Wohlfarth P, Beutel G, Lebiedz P, et al. Characteristics and outcome of patients after allogenic sterm cell transplantation treated with extracorporeal membrane oxygenation for acute respiratory distress syndrome. Crit care Med. 2017;45:e500–e507.Google Scholar
  51. 51.
    Mogal HD, Levine E, Fino N, et al. Routine Admission to Intensive Care Unit after cytoreductive surgery and heated intraperitoneal chemotherapy: not always a requirement. Ann Surg Oncol. 2015;23:1486–1495.PubMedPubMedCentralCrossRefGoogle Scholar
  52. 52.
    Song JU, Suh GY, Park HY, et al. Early intervention on the outcomes in critically ill cancer patients admitted to intensive care unit. Intensive Care Med. 2012;38(9):1505–13. Scholar
  53. 53.
    Soares M, Fontes F, Dantas J, et al. Performance of six severity-of-illness scores in cancer patients requiring admission to the intensive care unit: a prospective observational study. Crit Care Med. 2004;8(4):R194–203.PubMedPubMedCentralCrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Ignacio Pujol Varela
    • 1
    Email author
  • Isidro Prieto del Portillo
    • 1
  1. 1.Department of Critical CareHospital MD Anderson Cancer CenterMadridSpain

Personalised recommendations