Patients with hematological malignancies admitted to intensive care units: new challenges for the intensivist

Advances in treatment of cancer patients and improved understanding of pathophysiological mechanisms behind malignant diseases contribute to increased survival and, consequently, increasing needs of intensive care support for this population.(1) It should be highlighted that ‘cancer’ is a name generically given to a widely heterogeneous group of diseases; in comparison to solid tumors, hematological neoplasms show a number peculiar features. Among the most relevant, it should be emphasized the urgency of starting anticancer therapy, as often required in high-grade hematological neoplasms as acute leukemia and aggressive lymphomas. Specific research on this subgroup is warranted, considering the potential prognostic impact of the underlying neoplasm behavior and center-specific features (such as volume of cases, availability of anti-cancer agents and specific diagnosis techniques).(2) In the past two decades, intensive care units (ICU) increasingly played a relevant role, both treating infective intercurrences and severe complications related to the cancer itself and its therapy; and preventive admissions of high-risk patients undergoing chemotherapy.(3) Currently, refusing ICU admissions based only on the type of hematological cancer is no longer justifiable. Therefore, the intensive care specialty faces new challenges represented by severely ill patients with malignant underlying diseases requiring, in addition to traditional intensive care, progressively more specific knowledge on oncology.(4) These new and progressive challenges require the intensivist to be capable of offering both the best clinical care and appropriate advice for patient and family members regarding prognosis, therapeutic options and preferences. Therefore, some behavioral changes are required, particularly regarding improved cooperation between intensivists and oncologists/hematologists. In addition to influencing the clinical practice and decision making on anti-cancer therapy, this interaction may contribute to appropriately select patients who may better benefit from intensive care.(4) A suitable example of such cooperation is giving urgent intravenous chemotherapy to hematological patients during their ICU stay. This cooperation has been shown feasible, adding a positive impact on selected patients’ prognosis, including for those with highly severe diseases.(3,5) Some independent aspects associated to poor prognosis in severely ill hematological cancer patients have been identified, such as the need of invasive respiratory support, more organ dysfunctions, poor performance status and Viviane Bogado Leite Torres1, Marcio Soares1,2,3