Buchtele Nina, Munshi Laveena
Intensive Care Unit 13i2, Department of Medicine I, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
Interdepartmental Division of Critical Care Medicine, Mount Sinai Hospital, Sinai Health System, University of Toronto, Toronto, Canada.
Med Klin Intensivmed Notfmed. 2025 Aug 29. doi: 10.1007/s00063-025-01320-6.
A thorough understanding of oncological disease status is crucial for managing critically ill patients with cancer. The cancer trajectory predisposes patients to the type of critical illness they could develop and shapes the likelihood of reversibility and the chance for meaningful recovery, including continuation of therapy. This review outlines how disease status-whether new diagnosis, remission, stable disease, or progression-directly impacts differential diagnosis and treatment goals in the intensive care unit (ICU). Prognosis can be subdivided into (1) the comorbid cancer condition and (2) the acute critical care condition. Factors that impact prognosis may be similar including patient frailty, extent of organ failure, and tumor-related factors. While ICU survival remains an important patient-centered outcome, long-term outcomes such as return to treatment and acceptable quality of life have become increasingly important as ICU survival has improved over the past decades. Clear communication about patient values helps align care with realistic goals and avoid disproportionate ICU treatment. However, a critical element of establishing realistic goals includes a thorough understanding of the oncologic disease status. Close collaboration between intensivists and oncologists improves prognostication, treatment planning, and advance care discussions. Early recognition of high-risk patients and clear escalation or limitation pathways help ensure timely ICU transfer when needed. After ICU discharge, coordinated follow-up and rehabilitation support recovery and candidacy for further oncological treatment. An integrated, goal-directed approach enables tailored care for this complex patient group and supports shared decision-making throughout the continuum of cancer care.
全面了解肿瘤疾病状况对于管理重症癌症患者至关重要。癌症发展轨迹使患者易患可能出现的重症类型，并决定了病情可逆的可能性以及实现有意义康复（包括继续治疗）的机会。本综述概述了疾病状况（无论是新诊断、缓解、疾病稳定还是进展）如何直接影响重症监护病房（ICU）的鉴别诊断和治疗目标。预后可细分为：（1）合并癌症状况；（2）急性重症监护状况。影响预后的因素可能相似，包括患者虚弱程度、器官衰竭程度和肿瘤相关因素。虽然ICU生存仍然是以患者为中心的重要结局，但随着过去几十年ICU生存率的提高，诸如恢复治疗和可接受的生活质量等长期结局变得越来越重要。关于患者价值观的清晰沟通有助于使护理与现实目标保持一致，并避免过度的ICU治疗。然而，确立现实目标的一个关键要素包括全面了解肿瘤疾病状况。重症医学专家和肿瘤学家之间的密切合作可改善预后评估、治疗规划和预立医疗照护讨论。早期识别高危患者以及明确的升级或限制途径有助于确保在需要时及时将患者转入ICU。在患者从ICU出院后，协调的随访和康复支持恢复以及进一步肿瘤治疗的候选资格。一种综合的、目标导向的方法能够为这一复杂患者群体提供个性化护理，并支持在整个癌症护理过程中进行共同决策。
