Kanji Salmaan, MacLean Erica, Rashid Farah Joy, Pittman Michelle, Trinacty Melanie, Allan David, Rosenberg Erin
, PharmD, is with The Ottawa Hospital and the Ottawa Hospital Research Institute, Ottawa, Ontario.
, BScPharm, is with The Ottawa Hospital, Ottawa, Ontario.
Can J Hosp Pharm. 2020 Fall;73(4):279-287. Epub 2020 Oct 1.
Administration of chemotherapy to highly vulnerable, critically ill patients in the intensive care unit (ICU) is becoming more common, but the process requires significantly more resources than chemotherapy administration in specialized oncology settings.
To describe the context, complications, and outcomes of chemotherapy administration for cancer-related indications in ICU patients.
For this retrospective observational study, consecutive patients receiving parenteral chemotherapy in the ICU at the General Campus of The Ottawa Hospital between January 1, 2014, and December 31, 2017, were identified using pharmacy records. The clinical characteristics of these patients, details of their chemotherapy regimens, and outcomes were analyzed.
A total of 32 patients were included in the study. Of these, 27 patients (84%) had a hematological malignancy, 16 (50%) had a documented infection at the time of chemotherapy administration, and 29 (91%) received their first cycle of chemotherapy on an urgent basis during the ICU admission rather than as a scheduled or planned treatment. Severity of illness was high both at ICU admission and at the time of chemotherapy treatment; regimen modifications, drug interactions, and adverse events were common. Remission and survival data were available for 28 patients at 12 months. Eighteen (56%) of the 32 patients survived to hospital discharge, and 12 (38%) survived to 6 months; at 12 months, survival was 25% (7 of 28 patients with available data). About one-quarter of the patients were in remission at 6 and 12 months.
Administering chemotherapy in the ICU is feasible, but the process is resource-intensive. Patients with aggressive hematological cancers who require treatment on an urgent basis represent the most commonly observed scenario. This study highlights the complexity of management and the importance of multidisciplinary care teams for this patient population.
在重症监护病房（ICU）对极度脆弱的重症患者进行化疗正变得越来越普遍，但这一过程所需的资源比在专门的肿瘤治疗环境中进行化疗要多得多。
描述ICU患者因癌症相关指征进行化疗的背景、并发症及结果。
在这项回顾性观察研究中，利用药房记录确定了2014年1月1日至2017年12月31日期间在渥太华医院总院ICU接受胃肠外化疗的连续患者。分析了这些患者的临床特征、化疗方案细节及结果。
该研究共纳入32例患者。其中，27例（84%）患有血液系统恶性肿瘤，16例（50%）在化疗时记录有感染，29例（91%）在ICU住院期间接受了首个化疗周期的紧急化疗，而非按计划或预定治疗。在ICU入院时和化疗时病情严重程度均较高；方案调整、药物相互作用及不良事件很常见。有28例患者在12个月时可获得缓解和生存数据。32例患者中有18例（56%）存活至出院，12例（38%）存活至6个月；在12个月时，生存率为25%（28例有可用数据的患者中有7例）。约四分之一的患者在6个月和12个月时处于缓解状态。
在ICU进行化疗是可行的，但该过程资源密集。急需治疗的侵袭性血液系统癌症患者是最常见的情况。本研究强调了管理的复杂性以及多学科护理团队对这一患者群体的重要性。
