Intensive Care in Patients with Solid Tumours: A Practical Framework for Integrated Onco-Critical Care
5 affiliations
- 1Department of Medical Oncology, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain
- 2Department of Intensive Care Medicine, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain
- 3Department of Internal Medicine, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain
- 4Hospital Ruber Juan Bravo, 28006 Madrid, Spain
- 5Co-Management Working Group, Sociedad Española de Medicina Interna, 28016 Madrid, Spain
Abstract
The number of patients with solid tumours requiring intensive care is increasing as cancer survival improves and oncological treatments become more complex. Intensive care unit (ICU) admission decisions should not be based on cancer diagnosis, metastatic status or palliative treatment intent alone. This narrative review presents a practical, multidisciplinary framework for assessing critically ill patients with solid tumours. It integrates acute illness severity and reversibility, organ failure, baseline performance status and frailty, cancer trajectory, remaining treatment options, expected functional recovery and patient preferences. We discuss contemporary anticancer treatment toxicities, cancer-associated thromboembolic disease, older adults, palliative care, communication and ethical decision-making. We also propose an algorithm ranging from full ICU support to a time-limited ICU trial with predefined reassessment or comfort-focused care. Early joint assessment by oncology and intensive care teams, followed by dynamic reassessment, may reduce both inappropriate escalation and premature exclusion from potentially beneficial organ support. Future research should prioritize structured pathways, improved prognostic tools and outcomes beyond survival, including functional recovery, quality of life and the ability to resume meaningful cancer treatment.
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BibTeX
@article{casteloloureiro2026intensive,
title = {{Intensive Care in Patients with Solid Tumours: A Practical Framework for Integrated Onco-Critical Care}},
author = {Alicia Castelo-Loureiro and Amanda Lesmes González de Aledo and Mateo Bover Larroya and Zaira Molina Collado and Cristina Serrano Gómez and Isaías Martín Badía and Jesús González Olmedo and Santiago Terán and Marcos Valiente Fernández and Carlos Heredia-Mena and Joseph Exebio-Jara and Lidia Orejón García and María Carnevali Frías and Carlos Gómez Martín and María Cruz Martín Delgado and Luis Paz-Ares},
journal = {Cancers},
year = {2026},
month = oct,
doi = {10.3390/cancers18193210},
url = {https://europepmc.org/article/PMC/PMC13664010},
note = {CC BY},
}
RIS
TY - JOUR
TI - Intensive Care in Patients with Solid Tumours: A Practical Framework for Integrated Onco-Critical Care
AU - Alicia Castelo-Loureiro
AU - Amanda Lesmes González de Aledo
AU - Mateo Bover Larroya
AU - Zaira Molina Collado
AU - Cristina Serrano Gómez
AU - Isaías Martín Badía
AU - Jesús González Olmedo
AU - Santiago Terán
AU - Marcos Valiente Fernández
AU - Carlos Heredia-Mena
AU - Joseph Exebio-Jara
AU - Lidia Orejón García
AU - María Carnevali Frías
AU - Carlos Gómez Martín
AU - María Cruz Martín Delgado
AU - Luis Paz-Ares
PY - 2026
DA - 2026/10/01
JO - Cancers
DO - 10.3390/cancers18193210
UR - https://europepmc.org/article/PMC/PMC13664010
AB - The number of patients with solid tumours requiring intensive care is increasing as cancer survival improves and oncological treatments become more complex. Intensive care unit (ICU) admission decisions should not be based on cancer diagnosis, metastatic status or palliative treatment intent alone. This narrative review presents a practical, multidisciplinary framework for assessing critically ill patients with solid tumours. It integrates acute illness severity and reversibility, organ failure, baseline performance status and frailty, cancer trajectory, remaining treatment options, expected functional recovery and patient preferences. We discuss contemporary anticancer treatment toxicities, cancer-associated thromboembolic disease, older adults, palliative care, communication and ethical decision-making. We also propose an algorithm ranging from full ICU support to a time-limited ICU trial with predefined reassessment or comfort-focused care. Early joint assessment by oncology and intensive care teams, followed by dynamic reassessment, may reduce both inappropriate escalation and premature exclusion from potentially beneficial organ support. Future research should prioritize structured pathways, improved prognostic tools and outcomes beyond survival, including functional recovery, quality of life and the ability to resume meaningful cancer treatment.
SN - 2072-6694
ER -