Use of Chemotherapy and Other Cancer-Directed Therapies in the ICU for Patients with Cancer.

Abstract

The global burden of cancer is rising, and patients with malignancy who are critically ill account for 15%-20% of intensive care unit (ICU) admissions. A common indication for ICU admission is the presence of oncological emergencies that require organ support or close monitoring, while patients receive cancer therapy. The administration of chemotherapy in the ICU for selective patients with malignancy is feasible and is associated with considerable long-term survival and disease-free survival. Newer therapies such as targeted therapies and immunotherapies have significantly improved prognosis in malignancies that were considered terminal, and their use continues to increase exponentially. While indications surrounding chemotherapy treatment in the ICU are well documented, the role of these newer therapies in the setting of oncologic emergencies and critical illness is not well reported. This review summarizes the available evidence regarding the timing and indications for administration of chemotherapy and newer cancer regimens in the ICU for hematological and solid malignancies, its associated complications, emerging therapeutic options, and overall prognosis.