Providing High-Quality and Affordable Intensive Care to Patients With Cancer: The Forgotten Brick in the Steep Wall of Costs Throughout the Cancer Care Continuum

1. Márcio Soares⇑ and
2. Jorge I.F. Salluh

+ Author Affiliations

1. Instituto Nacional de Câncer; D'Or Institute for Research and Education, Rio de Janeiro, Brazil

1. Corresponding author: Márcio Soares, MD, PhD, D'Or Institute for Research and Education, Rua Diniz Cordeiro, 30 -3 ° andar; Rio de Janeiro, Brazil, CEP 22281 -100; e-mail: marciosoaresms@gmail.com.

 

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To the Editor:

The article by Shih et al¹ summarized the activities of the workshop entitled “Delivering Affordable Cancer Care in the 21st Century” led by the National Cancer Policy Forum of the Institute of Medicine. We congratulate the authors for such work that, as remarked by themselves, describes the challenges posed by the increasing costs of cancer care as being exemplary of those facing the health care system as whole, driven significantly by an aging population. Many concerns regarding the implications of the overuse and/or inappropriate use of screening and therapeutic strategies (in particular, the new therapies and technologies) for the costs of cancer care were raised by the authors. 

In addition, there is urgent need for improvements in supportive care for these patients. In this sense, the growing demand for intensive care represents another critical and forgotten facet of a complex problem. Intensive care–related costs in the United States (estimated at $82 billion in 2005) account for 13% of hospital expenditures and approximately 1% of the gross domestic product.² Although many targets to improve the provision of supportive care for patients with cancer were addressed, the discussion was restricted to palliative care. Nonetheless, intensive care units (ICUs) are essential for the supportive care of patients with cancer; up to one in five patients admitted to ICUs have cancer.³ It is well known that survival of critically ill patients with cancer has improved significantly in recent years, even in the case of respiratory failure or severe infection.³ In contrast, many patients with cancer are still inappropriately admitted to the ICU at the end of life.⁴ However, because triage procedures are inaccurate even in specialized centers,⁵ the broadening of ICU admission policies has been recommended by experts worldwide.³

For all these reasons, the provision of intensive care to an increasing number of patients with cancer deserves to be included in any future agenda of care planning for these patients. Along this lines, future investigations should address the roles of fast-track postoperative care, planned recovery tracks, dehospitalization programs, rehabilitation, and hospice-based care for patients with cancer who survive ICU stays. Meanwhile, close collaboration between oncologists and intensivists coupled with the need to document patient preferences for aggressive therapies and end-of-life issues at the time of ICU admission are essential to avoid either depriving patients who may benefit from life-sustaining treatments or, conversely, inappropriately prolonging the end of life. Integrating palliative and intensive care is paramount to achieving high-quality and affordable supportive care that will meet the needs of patients, family members, care providers, and society.

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AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST

The author(s) indicated no potential conflicts of interest.

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