Decision for Intensity of Treatment for Onco-patients After ICU Admission

Intensive care unit (ICU) admission is generally required in patients suffering from cancer for management of any acute illness as a sequel to the underlying malignancy or related to complications of ongoing therapy for existing malignancy. Predicting the prognosis of cancer patients with any acute illness becomes a key factor for making clinical decisions for ICU admission and the aggressiveness of intensive care to be provided to these patients. Similar illness severity scores that exist for general ICU patients have also been used for onco-patients at the time of ICU admission for the best utilization of ICU resources. The prognosis of these patients has shown a consistent improvement over the last few decades, even if they suffer from life-threatening complications requiring emergent ICU admission. However, the most consistent factor that has been found to predict the outcome is the involvement of organ failures during ICU admission. The management/support of the organ failures in these patients is similar to any other general ICU patient. Limiting the intensity of treatment or providing end-of-life care in this cohort requires a multidisciplinary approach among the intensive care physicians, hematologists, and treating teams of other disciplines involved in patient care. In this chapter, the authors discuss the indications, severity of ICU admission, and management of onco-patients requiring ICU admission.