Antonio Paulo Nassar1,2, Aldo Lourenço Abadde Dettino3, Cristina Prata Amendola4, Rodrigo Alves Dos Santos4,5, Daniel Neves Forte2,6, Pedro Caruso1,7. 1. 1 Intensive Care Unit, A.C. Camargo Cancer Center, São Paulo, Brazil. 2. 2 Intensive Care Unit, Discipline of Medical Emergencies, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil. 3. 3 Department of Oncology, A.C. Camargo Cancer Center, São Paulo, Brazil. 4. 4 Intensive Care Unit, Pio XII Foundation, Barretos Cancer Hospital, Barretos, Brazil. 5. 5 Barretos School of Health Sciences, Barretos, Brazil. 6. 6 Department of Palliative Care, Hospital Sírio Libanês, São Paulo, Brazil. 7. 7 Pulmonary Division, Heart Institute (InCor), Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
Abstract
BACKGROUND: Patients with cancer represent an important proportion of intensive care unit (ICU) admissions. Oncologists and intensivists have distinct knowledge backgrounds, and conflicts about the appropriate management of these patients may emerge. METHODS: We surveyed oncologists and intensivists at 2 academic cancer centers regarding their management of 2 hypothetical patients with different cancer types (metastatic pancreatic cancer and metastatic breast cancer with positive receptors for estrogen, progesterone, and HER-2) who develop septic shock and multiple organ failure. RESULTS: Sixty intensivists and 46 oncologists responded to the survey. Oncologists and intensivists similarly favored withdrawal of life support measures for the patient with pancreatic cancer (33/46 [72%] vs 48/60 [80%], P = .45). On the other hand, intensivists favored more withdrawal of life support measures for the patient with breast cancer compared to oncologists (32/59 [54%] vs 9/44 [21%], P < .001). In the multinomial logistic regression, the oncology specialists were more likely to advocate for a full-code status for the patient with breast cancer (OR = 5.931; CI 95%, 1.762-19.956; P = .004). CONCLUSIONS: Oncologists and intensivists share different views regarding life support measures in critically ill patients with cancer. Oncologists tend to focus on the cancer characteristics, whereas intensivists focus on multiple organ failure when weighing in on the same decisions. Regular meetings between oncologists and intensivists may reduce possible conflicts regarding the critical care of patients with cancer.
BACKGROUND: Patients with cancer represent an important proportion of intensive care unit (ICU) admissions. Oncologists and intensivists have distinct knowledge backgrounds, and conflicts about the appropriate management of these patients may emerge. METHODS: We surveyed oncologists and intensivists at 2 academic cancer centers regarding their management of 2 hypothetical patients with different cancer types (metastatic pancreatic cancer and metastatic breast cancer with positive receptors for estrogen, progesterone, and HER-2) who develop septic shock and multiple organ failure. RESULTS: Sixty intensivists and 46 oncologists responded to the survey. Oncologists and intensivists similarly favored withdrawal of life support measures for the patient with pancreatic cancer (33/46 [72%] vs 48/60 [80%], P = .45). On the other hand, intensivists favored more withdrawal of life support measures for the patient with breast cancer compared to oncologists (32/59 [54%] vs 9/44 [21%], P < .001). In the multinomial logistic regression, the oncology specialists were more likely to advocate for a full-code status for the patient with breast cancer (OR = 5.931; CI 95%, 1.762-19.956; P = .004). CONCLUSIONS: Oncologists and intensivists share different views regarding life support measures in critically ill patients with cancer. Oncologists tend to focus on the cancer characteristics, whereas intensivists focus on multiple organ failure when weighing in on the same decisions. Regular meetings between oncologists and intensivists may reduce possible conflicts regarding the critical care of patients with cancer.
Authors: M G Kiehl; G Beutel; B Böll; D Buchheidt; R Forkert; V Fuhrmann; P Knöbl; M Kochanek; F Kroschinsky; P La Rosée; T Liebregts; C Lück; U Olgemoeller; E Schalk; A Shimabukuro-Vornhagen; W R Sperr; T Staudinger; M von Bergwelt Baildon; P Wohlfarth; V Zeremski; P Schellongowski Journal: Ann Hematol Date: 2018-04-27 Impact factor: 3.673
Authors: Jin Hwa Song; Sooyeon Kim; Hyun Woo Lee; Yeon Joo Lee; Mi-Jung Kim; Jong Sun Park; Yu Jung Kim; Ho Il Yoon; Jae Ho Lee; Jong Seok Lee; Choon-Taek Lee; Young-Jae Cho Journal: PLoS One Date: 2019-02-13 Impact factor: 3.240