Defining intensive care status in metastatic lung cancer patients: A French survey

Improved lung cancer survival has led to an increase in situations requiring intensive care unit (ICU) admission. Establishing appropriate criteria for ICU admission and withholding/withdrawing life-sustaining treatment for these patients remains challenging.

A national multicentre prospective survey was conducted in France from August to November 2023. Participants responded to fictitious clinical cases representing three patients with metastatic lung cancer, either small cell lung cancer (SCLC) or non-SCLC (NSCLC), in a total of nine clinical situations (three each). We aimed to investigate the medical decision-making process for care intensity and explore associations with physician characteristics, patient disease status, and emergency situations.

Overall, 305 physicians participated in this survey, primarily from oncology (33%) and intensive care (56%) departments. In case of febrile aplasia, ICU admission was proposed by 88%, 81%, and 64% of respondents for NSCLC in first line, NSCLC in second line, and SCLC in first line, respectively. Conversely, in case of tumour obstruction, only 44%, 32%, and 23% of physicians proposed ICU, respectively. The three main variables used in the decision-making process were performance status (63%), complication reversibility (61%), and anticancer treatment efficacy (40%). The suggestions of oncologists and intensivists appeared often similar, contrary to those of emergency physicians.

This survey reported similar care intensity provided by oncologists and intensivists. ICU admission was more often proposed in case of expected reversibility of organ failure. This highlights the importance of multidisciplinary discussion, standardised protocols, and training in critically ill cancer patient care.