Q&A: Critical Care for Cancer Patients
CancerWise - January 2009
Cancer patients may need critical, or intensive, care for conditions caused by their cancer or its treatment, or for other health problems unrelated to cancer.
Answering questions about critical care for cancer patients are two physicians in the Department of Critical Care at M. D. Anderson:
- Kristen Price, M.D., professor and chair
- Joseph Nates, M.D., professor, deputy chair and medical director, Intensive Care Unit (ICU)
What is critical care?
Price: The critical care or intensive care unit is a specialized area where patients who are critically ill receive care, such as life support or more invasive forms of heart monitoring they can’t get on a regular care floor.
As a medical specialty, critical care trains intensivists, special doctors who care for these types of patients. They may be trained in internal medicine, anesthesiology or surgery.
Why do cancer patients need critical care?
Price: Cancer patients may need critical care because of:
Respiratory failure: As the most common reason cancer patients need critical care, respiratory failure may be due to pneumonia, bleeding in the lungs or any condition that means a patient cannot breath on his or her own and requires a mechanical ventilator.
Cancer surgery: People who have major cancer surgery sometimes come to critical care for post-surgery monitoring and measurement. Complications from surgery, like bleeding or infection, may cause them to need specialized care.
Life-threatening effects of cancer treatment: These may be caused by chemotherapy or radiation.
Infections: Cancer patients’ immune systems may be compromised as a result of treatment. Infections can lead to shock and major organ damage and become life-threatening.
Underlying medical conditions: If patients have serious conditions, like diabetes or heart disease, in addition to cancer, they may require critical care.
Progression of cancer: As a tumor grows, critical care may become necessary. For instance, respiratory distress may be caused by a large tumor in the lung, or accumulation of fluid in the lining of the lungs or heart.
Is critical care for cancer becoming more common?
Price: Yes. As better cancer treatments are developed, people are surviving longer. And as critical care improves, it will improve cancer outcomes as well.
But not all cancer patients are the same, and that’s where it becomes challenging. The decision whether or not a cancer patient should be treated in the ICU really needs to be based on his or her realistic chances for survival, as well as quality of life after discharge.
How are those decisions made?
Price: For the general population, standard scoring systems have been developed to help estimate a patient’s chance of survival. Research at M. D. Anderson has shown these systems underestimate cancer patients’ chances of dying when they come to the ICU.
We’ve done research that resulted in a model to more accurately predict outcome in cancer patients. But like all such models, it can be used only as a decision-making tool to help the physician determine the patient’s probability of surviving with good quality of life.
A lot more research needs to be done to predict which cancer patients will do poorly in the ICU. Physicians need to have frank discussions with patients about whether the patients would benefit from critical care.
At M. D. Anderson, intensivists work closely with the patient’s primary oncologist to determine who receives critical care.
Do all cancer centers have similar critical care units?
Nates: The size of critical care units and how critical care is delivered varies widely among cancer centers and other hospitals.
In the United States, only about 30% of critically ill patients receive care from intensivists. In small towns, that figure is even lower because of the availability of specialized care and separate facilities.
At hospitals that do not have intensive care units specifically for cancer, the decision whether to admit a patient to the ICU generally is made by the primary oncologist in consultation with a pulmonologist (physician specially trained to diagnosis and treat lung disorders) or a physician trained to treat patients in the ICU.
What would you tell a cancer patient who might need critical care?
Nates: We recommend people seek cancer treatment in the place they can afford that has the largest volume and most experience in the particular type of cancer they need to address. This usually is associated with the best outcomes.
M. D. Anderson resources:
CancerWise - January 2009
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- Q&A: Critical Care for Cancer Patients
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