2055P - Multidisciplinary Tumor-ICU Board: Enhancing care for critically Ill patients with solid tumors in the ICU

Background

Patients with solid tumors frequently experience complications that may require ICU admission. The advent of new cancer treatments such as has added complexity and potential adverse events, which frequently mimic severe infections or critical disorders. Therefore, there is a need to evaluate patients with solid tumors in the ICU from multiple perspectives. We aim to establish a Multidisciplinary Board to customize diagnostic and treatment approaches for critically ill patients with solid tumors in the ICU, through a comprehensive evaluation by ICU, Hematology (HEM), Infectious Diseases (ID), and Medical Oncology (MO) specialists.

Methods

Specialists from the Vall d’Hebron ICU, ID, and MO meet weekly to discuss prospectively clinical evolution, how to tailor treatments and further diagnostic steps of patients with solid tumors admitted to the ICU.

Results

From January to April 2023, 46 patients with solid tumors were evaluated by the ICU-Tumor board. The majority (65%) were male, with a median age of 62 years. Gastrointestinal tumors accounted for 44% of the cases, followed by lung cancers (17%), head and neck tumors (11%), and other malignancies (28%). Overall, 17% of the patients were receiving potentially radical treatment (NA or ADJ treatment), and 83% presented with metastatic disease. Respiratory failure (65%), septic shock (11%), metabolic disturbances (10%) and other events (14%) were the most frequent reasons for ICU admission which were caused by infectious events (51%), treatment toxicity (22%), and cancer-related complications (27%). Median time admitted at the ICU was 10 days (1-83 days). The Board's most common recommendations included diagnostic procedures (50%, biopsy or radiological evaluations) therapeutic interventions (30%) (antibiotic, immunosuppression or start chemotherapy in the ICU), and limiting treatment intensity (10%). Mortality within the ICU was 10%, and 30-day mortality was 39%.

Conclusions

The Multidisciplinary ICU-tumor Board's recommendations range from diagnostic to therapeutic interventions and can lead to improved outcomes and tailor therapeutic strategies for these critically ill patients, particularly with the increased complexity of new cancer treatments and complex infections.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

F.J. Ros Montana: Financial Interests, Personal, Speaker, Consultant, Advisor: Amgen, Merck; Financial Interests, Other: Pierre-Fabre. N. Saoudi Gonzalez: Financial Interests, Personal, Speaker, Consultant, Advisor: Amgen. J. Carles Galceran: Financial Interests, Personal, Advisory Board: Astellas Pharma, AstraZeneca, Bayer, Johnson & Johnson, MSD Oncology, Novartis (AAA), Roche, Sanofi; Financial Interests, Institutional, Local PI: Janssen-Cilag International NV, Lilly, S.A, MedImmune, Novartis Farmacéutica, S.A, Sanofi-Aventis, S.A; Other, Member of the Comission: Catalan Program of Ambulatory Medication Comission (CAHMDA). M.E. Elez Fernandez: Financial Interests, Personal, Advisory Board: Hoffmann-La Roche, Servier, Amgen, Merck Serono, Sanofi, Bayer, Pierre Fabre, MSD; Financial Interests, Personal, Invited Speaker: Organon, Novartis; Financial Interests, Personal, Other, Educational training: Seagen International GmbH; Financial Interests, Institutional, Funding: Hoffmann-La Roche Ltd, Sanofi Aventis Recherche & Développement, Amgen Inc., Boehringer Ingelheim, Novartis Farmacéutica SA, Bristol Myers Squibb International Corporation, BeiGene, HalioDX SAS, Janssen-Cilag SA, Merck Health KGAA, Merck Sharp & Dohme de España SA, PharmaMar SA, Servier, Taiho Pharma USA Inc, Hutchison MediPharma International, Menarini, Merus NV, Pfizer, Mirati, Array Biopharma Inc, AstraZeneca Pharmaceuticals LP, Celgene International SARL, Debiopharm International SA, Genentech Inc, MedImmune; Non-Financial Interests, Other, Coordinator of the SEOM +MIR Section of Residents and Young Assistants: Sociedad Española de Oncología Médica (SEOM); Non-Financial Interests, Other, Speaker of the ESMO Academy: European Society for Medical Oncology (ESMO); Non-Financial Interests, Other, Volunteer member of the ASCO Annual Meeting Scientific Program Committee: Developmental Therapeutics – Immunotherapy: American Society of Clinical Oncology (ASCO); Other, Travel, accommodations, expenses: Roche, Merck Serono, Sanofi, Amgen, Array BioPharma, Servier, Bristol Myers Squibb. All other authors have declared no conflicts of interest.