Immunotherapy improves the prognosis of lung cancer: do we have to change intensive care unit admission and triage guidelines?

Guillon, A. et al. Critical Care. Published online: 27 January 2017

Bald heads may soon not be a sign that identifies a cancer patient receiving treatment. Indeed, therapies for cancer patients are improving dramatically leading to increased survival rates, and most are associated with a different toxicity profile. Recently, antibody-based therapy has transformed the therapeutic landscape and biology of non-small cell lung cancer (NSCLC) and other solid tumors. This may also reshuffle the playing cards for an intensive care unit (ICU) admission policy due to improved outcomes.

In November 2016, the results of the KEYNOTE-024 trial showed for the first time the superiority of immunotherapy over chemotherapy as first-line treatment for NSCLC [1]. In this phase 3 trial, a humanized monoclonal antibody (mAb) against programmed death 1 (PD-1) was tested in patients who had previously untreated advanced NSCLC. The clinical trial was stopped by the safety monitoring committee on the basis of substantial clinical benefit of immunotherapy, and patients remaining in the chemotherapy group were switched to receive immunotherapy.

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Effectiveness of critical care pathways for head and neck cancer surgery: A systematic review

 Gordon, S.A. & Reiter, E.R. Head & Neck. Published online: 8 July 2016

N0014037 MRI scan; spinal cord cancer (glioma), cervical
Image source: Wellcome Images // CC BY-NC-ND 4.0

Image shows MRI of lateral neck showing cervical cord glioma.

Background: Critical care pathways (CCPs) are implemented within health care systems as a means to systematically decrease resource utilization, whereas maintaining a high level of care for patients with a specific diagnosis. Previous studies have shown equivocal results for CCPs in head and neck cancer surgery.

Methods: We conducted a systematic review evaluating studies of CCPs for head and neck cancer surgery, with individual outcome measures analyzed separately to describe the effect of each implemented pathway.

Results: Ten before and after studies were included for systematic review. Nine reported statistically significant decreases in median/mean length of stay and 5 reported statistically significant decreases in cost of care per case.

Conclusion: Although the results are encouraging and point toward the ability of CCPs to decrease length of stay and cost of care, the evidence cannot be considered exhaustive because of the studies’ inability to account for temporal trends. Further controlled studies are recommended to validate the benefits of CCPs.

Read the abstract here