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 Table of Contents  
REVIEW ARTICLE
Year : 2019  |  Volume : 3  |  Issue : 1  |  Page : 52-53

Adult cancer patients admitted to the critical care unit in Saudi Arabia


1 Department of Emergency Medicine and Critical Care, King Fahad Medical City, Riyadh, Saudi Arabia
2 Department of General Surgery and Critical Care, King Fahad Medical City, Riyadh, Saudi Arabia

Date of Web Publication30-May-2019

Correspondence Address:
Mohammed A AlMaani
Department of Emergency Medicine and Critical Care, King Fahad Medical City, Riyadh
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2543-1854.259470

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  Abstract 


Cancer is one of the leading causes of death globally. The incidence of cancer is increasing worldwide with a huge burden on healthcare resources. Oncology patients require highly specialized care that is not widely available. In Saudi Arabia, data on cancer incidence are limited. Furthermore, many patients with cancer are diagnosed at advanced stages due to limited implementation of screening programs. This leads to difficulty in treating cancer patients and leads to families' dissatisfaction as well. Cancer patients require critical care services more frequently compared to other patients due to the nature of their disease and sometimes due to the complications of the treatment. Admitting patients with advanced cancer to critical care was debatable due to the poor outcome. However, the outcome of these patients has dramatically improved in the last decade, so no bias should be exercised when they need intensive care unit (ICU). In this review, we review the literature regarding the outcome of cancer patients admitted to the ICU focusing on Saudi Arabia.


How to cite this article:
AlMaani MA, Al Saied G. Adult cancer patients admitted to the critical care unit in Saudi Arabia. Saudi Crit Care J 2019;3:52-3

How to cite this URL:
AlMaani MA, Al Saied G. Adult cancer patients admitted to the critical care unit in Saudi Arabia. Saudi Crit Care J [serial online] 2019 [cited 2021 Mar 1];3:52-3. Available from: https://www.sccj-sa.org/text.asp?2019/3/1/52/259470



Cancer is the second leading cause of death globally and is responsible for an estimated 9.6 million deaths in 2018.[1] The economic impact of cancer is significant and is increasing. The total annual economic cost of cancer in 2010 was estimated at approximately US$ 1.16 trillion.[2]

Cancer patients require more tertiary care resource utilization compared to the general patient population because of the complications of their disease or its treatment. Chemotherapeutic agents cause bone marrow suppression which increase their risk of sepsis and serious bleeding. The risk of intensive care unit (ICU) admission is particularly high among patients with a hematologic malignancy due to their immunocompromised status. Sepsis (including neutropenic sepsis) is the most common reason for their ICU admission.[3]

Critically ill patients with cancer have poor short-term prognosis.[4] This ultimately leads to doubting the benefit of admitting cancer patients to critical care unit due to poor outcomes once admitted. However, healthcare providers should balance the improved survival of sepsis in the ICU in the last few decades, leading to reduction of overall mortality of septic shock (process trial).[5] Further, the advancement in cancer treatment with new modalities and less toxic agents has led to the overall improved mortality of cancer patient. Taccone et al. reported that hospital mortality of the patients with solid cancer was similar to the general ICU population, at 27%, and 23% respectively, whereas the mortality rate of hematological malignancy patients in the ICU remained high at 58%.[6] More recently, it was found that the ICU mortality for cancer patients was 36.5%, whereas life expectation at 1 year and 5 years was 22.8% and 14.2%, respectively.[7]

Data on cancer critically ill patients in Saudi Arabia are limited due to lack of systematic reporting and lack of availability of national registry for cancer critically ill patients. Al-Dorzi et al.[8] studied hematological malignancy patients who required intensive care admission and invasive mechanical ventilation and found a hospital mortality of 70.5%, with male gender (odds ratio [OR], 6.74; 95% confidence interval [CI], 2.24–20.30) and septic shock (OR, 6.61; 95% CI, 1.93–22.66) being predictors for mortality. We conducted a retrospective cohort study in a tertiary care center at Riyadh (unpublished data yet presented as an abstract at Canadian Critical Care Forum 2017) and we found the mortality rate of 37% for hematological and 43% for solid malignancies. The need for vasopressors and mechanical ventilation was associated with higher mortality.

We recommend having a national registry for cancer critically ill patient to guide projects aiming at improving the outcome of these patients and optimizing the use of resources.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Available from: http://www.who.int/mediacentre/factsheets/fs297/en/. [Last accessed on 2019 Mar 14].  Back to cited text no. 1
    
2.
3.
Pène F, Soares M. Can we still refuse ICU admission of patients with hematological malignancies? Intensive Care Med 2008;34:790-2.  Back to cited text no. 3
    
4.
Staudinger T, Stoiser B, Müllner M, Locker GJ, Laczika K, Knapp S, et al. Outcome and prognostic factors in critically ill cancer patients admitted to the intensive care unit. Crit Care Med 2000;28:1322-8.  Back to cited text no. 4
    
5.
ProCESS Investigators, Yealy DM, Kellum JA, Huang DT, Barnato AE, Weissfeld LA, et al. Arandomized trial of protocol-based care for early septic shock. N Engl J Med 2014;370:1683-93.  Back to cited text no. 5
    
6.
Taccone FS, Artigas AA, Sprung CL, Moreno R, Sakr Y, Vincent JL. Characteristics and outcomes of cancer patients in European ICUs. Crit Care 2009;13:R15.  Back to cited text no. 6
    
7.
Hawari FI, Nazer LH, Addassi A, Rimawi D, Jamal K. Predictors of ICU admission in patients with cancer and the related characteristics and outcomes: A 5-year registry-based study. Crit Care Med 2016;44:548-53.  Back to cited text no. 7
    
8.
Al-Dorzi HM, Al Orainni H, Al Eid F, Tlayjeh H, Itani A, Al Hejazi A, et al. Characteristics and predictors of mortality of patients with hematologic malignancies requiring invasive mechanical ventilation. Ann Thorac Med 2017;12:259-65.  Back to cited text no. 8
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