Study of Interactions Between Oncologists and Resuscitators to Optimize Decision Making for Admission of Patients With Metastatic Solid Cancer to the ICU (InterOncoRea)

Overview

The aim of our study is to optimise the interaction between oncologists and resuscitators to improve decision-making regarding the admission of patients with metastatic solid cancers to the ICU. The study is structured into two successive stages. The first stage involves a retrospective descriptive analysis of patients with metastatic solid cancer admitted to the ICU, to enable comparison with centres that have already documented this subject. The second stage involves personalised interviews with medical staff working in both the oncology department and the intensive care unit.

In the vast majority of cases, there is no cure for metastatic solid cancer. As a result, the question of end of life is very often present. End of life may be linked to the aggressiveness of the disease, to therapeutic damage, but also to an independent acute event that may occur during the course of oncology care. This explains why the question of resuscitation management comes into play in the care of our oncology patients. The literature shows that one in 7 patients admitted to intensive care in Europe has a history of cancer, and that 5 to 10% of cancer patients will require intensive care during their course of treatment. The therapeutic advances brought about by immunotherapy in the first instance, followed by targeted therapies in a second phase, have considerably altered the prognosis of patients with solid cancers, including the most aggressive cancers. However, given the poor prognosis of these diseases, having metastatic cancer continues to hinder a patient's possible admission to the intensive care unit. The second most common reason for refusing admission to the ICU is having cancer. Yet the post-ICU mortality rate for cancer patients is identical to that of the entire ICU patient group. Various scores have been used to determine the 'right' criteria for ICU admission for patients with metastatic solid cancers. Nevertheless, nothing appears to be more effective than communication between oncologists and intensive care physicians, particularly since the prognosis of patients with advanced cancers is still a subject of interdisciplinary discussion. Various scores have attempted to establish the 'right' criteria for admitting patients with metastatic solid cancers to intensive care. However, nothing appears more effective than discussions between oncologists and resuscitators, particularly given that the prognosis of patients with advanced cancers is still a topic of interdisciplinary debate. Indeed, the decision to admit a patient with metastatic cancer to an intensive care unit appears to raise ethical, medical and organisational issues. Bearing this in mind, and given the numerous studies already conducted in this area, we thought it would be interesting to examine the relationship between oncology and intensive care units. To study the interactions between intensive care physicians and oncologists and identify areas for improvement in patient care, we devised a two-stage approach. First, we conducted personalised semi-structured interviews with doctors from the medical oncology department (oncologists, organ specialists and general practitioners) and doctors from the intensive care unit. This allowed us to identify the obstacles that each speciality faces when admitting a patient to the intensive care unit. This would enable us to deduce the elements essential for reaching an agreement on admitting a patient to the intensive care unit (Stage 1). Secondly, we will review practices at Brest University Hospital (and possibly other centres that might be interested in our work) and compare them with data in the literature to see if our decisions are similar to those made in other centres that have already documented the subject (Stage 2).