|Year : 2019 | Volume
| Issue : 1 | Page : 52-53
Adult cancer patients admitted to the critical care unit in Saudi Arabia
Mohammed A AlMaani1, Ghiath Al Saied2
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 Publication||30-May-2019|
Mohammed A AlMaani
Department of Emergency Medicine and Critical Care, King Fahad Medical City, Riyadh
Source of Support: None, Conflict of Interest: None
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
Cancer is the second leading cause of death globally and is responsible for an estimated 9.6 million deaths in 2018. 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.
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.
Critically ill patients with cancer have poor short-term prognosis. 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). 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%. 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.
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. 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
Conflicts of interest
There are no conflicts of interest.
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