Cancer Related Escalation Decisions for ITU: Evaluation of patient outcomes. A NOTCH UK Retrospective Multi-centre Analysis
With growing numbers of targeted and immunotherapeutic treatment options, survival for patients with incurable (locally advanced or metastatic) cancer has significantly improved in recent years. Consequently, the notion that advanced cancer precludes admission to a critical-care environment is increasingly regarded as out-dated, in favour of personalised decision-making. A decision to admit patients with advanced cancer to critical-care however is complex, requiring detailed knowledge of their cancer, prognosis and remaining treatment options as well as understanding the likelihood of meaningful critical-care survival. As such decision making is often shared between oncology and critical-care specialists. There remains however, a paucity of data on critical-care outcomes with no validated predictive scoring indices for a UK specific advanced cancer population making escalation decisions challenging.
The project aims to provide robust UK specific critical-care outcome as well as quality of life data in this patient group. In addition we aim to assess the utility of physiological and biochemical parameters in both independently and collectively predicting these outcomes. In doing so we hope to identify a cohort of patients where escalation to critical care is likely to lead to meaningful survival and for other patients provide evidence to support discussions around ceiling of care. The project is a national collaborative, trainee led initiative involving professional working in both oncology and critical care.