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.