Chemotherapy in the Intensive Care Unit: An Evaluation of Context and Outcomes.

BACKGROUND

Administration of chemotherapy to highly vulnerable, critically ill patients in the intensive care unit (ICU) is becoming more common, but the process requires significantly more resources than chemotherapy administration in specialized oncology settings.

OBJECTIVE

To describe the context, complications, and outcomes of chemotherapy administration for cancer-related indications in ICU patients.

METHODS

For this retrospective observational study, consecutive patients receiving parenteral chemotherapy in the ICU at the General Campus of The Ottawa Hospital between January 1, 2014, and December 31, 2017, were identified using pharmacy records. The clinical characteristics of these patients, details of their chemotherapy regimens, and outcomes were analyzed.

RESULTS

A total of 32 patients were included in the study. Of these, 27 patients (84%) had a hematological malignancy, 16 (50%) had a documented infection at the time of chemotherapy administration, and 29 (91%) received their first cycle of chemotherapy on an urgent basis during the ICU admission rather than as a scheduled or planned treatment. Severity of illness was high both at ICU admission and at the time of chemotherapy treatment; regimen modifications, drug interactions, and adverse events were common. Remission and survival data were available for 28 patients at 12 months. Eighteen (56%) of the 32 patients survived to hospital discharge, and 12 (38%) survived to 6 months; at 12 months, survival was 25% (7 of 28 patients with available data). About one-quarter of the patients were in remission at 6 and 12 months.

CONCLUSION

Administering chemotherapy in the ICU is feasible, but the process is resource-intensive. Patients with aggressive hematological cancers who require treatment on an urgent basis represent the most commonly observed scenario. This study highlights the complexity of management and the importance of multidisciplinary care teams for this patient population.

CONTEXTE

L’administration de chimiothérapie á des patients hautement vulnérables et gravement malades admis dans une unité de soins intensifs (USI) est de plus en plus courante, mais le processus exige beaucoup plus de ressources que dans des environnements spécialisés en oncologie.

OBJECTIF

Décrire le contexte, les complications et les résultats de l’administration de chimiothérapie pour les indications liées au cancer de patients admis dans une USI.

MÉTHODES

Les patients successifs ayant participé á cette étude observationnelle rétrospective, qui recevaient une chimiothérapie parentérale dans une USI du Campus général de l’Hôpital d’Ottawa entre le 1

RÉSULTATS

Trente-deux (32) patients ont été inclus dans l’étude. Parmi eux, 27 (84 %) souffraient d’une hémopathie maligne, 16 (50 %) avaient une infection documentée au moment de l’administration de la chimiothérapie et 29 (91 %) recevaient en urgence le premier cycle de chimiothérapie pendant leur admission á l’USI plutôt que sous forme de traitement programmé ou planifié. Étant donné l’extrême gravité de la maladie lors de l’admission á l’USI et du traitement de chimiothérapie de ces patients, les modifications apportées au programme, les interactions médicamenteuses et les effets secondaires étaient fréquents. Les données relatives á la rémission et á la survie á 12 mois de 28 patients étaient disponibles. Le congé hospitalier a été donné á 18 (56 %) patients survivants sur les 32 admis et 12 (38 %) survivaient au 6

CONCLUSION

L’administration de chimiothérapie dans une USI est faisable, mais le processus exige beaucoup de ressources. Les patients atteints d’un cancer hématologique agressif qui ont besoin en urgence d’un traitement constituent le scénario le plus courant. Cette étude souligne la complexité de la gestion et l’importance des équipes de soins multidisciplinaires pour cette population de patients.

Informations de copyright

2020 Canadian Society of Hospital Pharmacists. All content in the Canadian Journal of Hospital Pharmacy is copyrighted by the Canadian Society of Hospital Pharmacy. In submitting their manuscripts, the authors transfer, assign, and otherwise convey all copyright ownership to CSHP.

Déclaration de conflit d'intérêts

Competing interests: Melanie Trinacty has received personal fees from Teva Pharmaceuticals for activities outside the work reported here. No other competing interests were declared.