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Oncological Critical Care

Cancer is a progressive, life-threatening condition with a high mortality rate, especially in its advanced stages. Patients with advanced stages of cancer have several emergency conditions, such as neurological disorders, cardiovascular complications, kidney injury, and acute respiratory failure, which can lead to emergency situations and may require admission in critical care. In addition, such patients have a unique need for care due to the underlying pathophysiology of cancer and treatment-related toxicities.

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Diseases and conditions

  • Tumor Lysis Syndrome: Tumor Lysis Syndrome occurs due to the destruction of a large number of cancer cells at a rapid rate, resulting in the release of their contents into the blood. It causes potassium, uric acid, and phosphorus levels to rise, thereby interfering with the functioning of several vital organs, such as the heart, kidneys, brain, and gastrointestinal system.
  • Neutropenic Sepsis: It is a life-threatening condition that is caused by the body's reaction to infection. It is one of the complications of anticancer therapy. Neutropenia is indicated when the neutrophil count in the blood is less than 0.5 × 109 /liter or less than 1.0 × 109 /liter and continues to drop.
  • BMT Complications: The complications that may occur due to bone marrow transplantation are graft-versus-host disease, organ damage, infections, graft failure, cataracts, new cancers, infertility, nausea and vomiting, change in taste and loss of appetite, oral sores, and death.
  • Tumor-Related Complications: Tumors may cause several complications in the body, especially during advanced stages. Some complications include malnourishment, bone pain, hypercalcemia, gastrointestinal obstruction, liver damage, lack of oxygen, serious damage to blood vessels, and an increased risk of infection. Patients with cancer may also have severe depression and anxiety and a significantly reduced quality of life.

Procedures and treatments

  • Advanced Antibiotic Management: Cancer patients are at increased risk of infection due to anticancer therapy. It is necessary to manage infections through appropriate antibiotics with minimal side effects. Advanced antibiotic management is also required preoperatively when the patient is undergoing surgery as a part of cancer treatment.
  • Anti-tumor lysis therapies: The therapy for tumor lysis syndrome is decided based on the severity of the disease. The common therapies for hyperuricemia in tumor lysis syndrome are diuretic therapy, aggressive intravenous hydration, inhibition of uric acid production, and urinary alkalinization. Patients with hyperkalemia are treated with bicarbonates and loop diuretics.
  • Blood component supplementation: Anticancer therapies have several side effects, including thrombocytopenia, granulocytopenia, and anemia. Blood component supplementation is recommended to manage these complications. Some of the blood components that can be supplemented are packed red blood cells, frozen-thawed red blood cells, leukocyte-poor packed red blood cells, platelets, granulocyte transfusions, and fresh frozen plasma.

Faq's

What is Oncological Critical Care?

Oncological Critical Care refers to specialized medical care provided to cancer patients who require intensive monitoring and treatment for critical conditions related to their cancer or its treatment.

What is Tumor Lysis Syndrome (TLS)?

Tumor Lysis Syndrome is a potentially life-threatening condition that can occur when cancer cells release large amounts of cellular components into the bloodstream, leading to metabolic imbalances. It may cause electrolyte abnormalities, kidney dysfunction, and cardiac complications.

How is Tumor Lysis Syndrome managed?

The management of Tumor Lysis Syndrome involves close monitoring of electrolyte levels, hydration, and administration of medications to control uric acid levels in the blood. In severe cases, dialysis may be necessary.

What is Neutropenic Sepsis?

Neutropenic Sepsis is a serious infection that occurs in individuals with low levels of neutrophils (a type of white blood cell) resulting from chemotherapy or bone marrow transplantation. It can lead to life-threatening complications if not promptly diagnosed and treated.

How is Neutropenic Sepsis treated?

Treatment for Neutropenic Sepsis typically involves immediate administration of broad-spectrum antibiotics along with supportive measures such as fluid resuscitation and close monitoring in an intensive care setting until the patient's immune system recovers.

What are BMT Complications?

BMT (Bone Marrow Transplantation) Complications refer to potential side effects or problems that may arise after undergoing this procedure. These can include graft-versus-host disease (GVHD), infections, organ damage, and other transplant-related complications requiring critical care interventions.

How are BMT Complications managed in Oncological Critical Care?

Management of BMT Complications requires a multidisciplinary approach involving close monitoring, immunosuppressive therapy for GVHD, antimicrobial treatments for infections, and supportive care to address organ dysfunction.

What are Tumor-Related Complications?

Tumor-Related Complications refer to various medical issues that arise directly from the presence or growth of cancer cells in the body. Examples include spinal cord compression, superior vena cava syndrome (SVCS), and malignant pleural effusions.

How are Tumor-Related Complications addressed in Oncological Critical Care?

The management of Tumor-Related Complications involves prompt diagnosis, symptom relief measures such as pain control or drainage procedures, and appropriate oncological interventions like radiation therapy or chemotherapy to target the underlying tumor causing the complication.

Why are cancer patients at increased risk of infection?

Neutrophils, a type of blood cell, protect the body against infection. Anticancer therapy reduces the number of these cells, thereby increasing the risk of infections in these patients.

What are the various complications of cancer treatment?

Various complications of cancer treatment include:

  • Chemotherapy-related complications: The complications related to chemotherapy are fatigue, anemia, loss of appetite, sore mouth, infections, hair loss, bruising, and bleeding.
  • Radiotherapy-related complications: Complications related to radiation therapy include fatigue, red, swollen, or irritated skin, low blood counts, and hair loss in the area being treated. Other complications of radiation therapy are site-specific.
  • Surgery-related complications: Complications of cancer surgery are pain, infection, bleeding, blood clots, loss of organ function, and changes in bowel and bladder function.