Integrating palliative care with intensive care for critically ill patients with lung cancer

Appropriate use of intensive care therapies for patients with lung cancer is a topic of continuing research and clinical interest. There has been a focus on issues related to intensive care unit (ICU) triage decision-making, such as whether expectations for clinically meaningful outcomes justify the burdens and costs of critical care treatment for lung cancer patients, and whether predictors at the time of ICU admission or during a trial of intensive care can help to refine our evaluation of potential risks and benefits [1-6]. As new data emerge from studies of lung cancer screening, staging, drug development, and molecular diagnostics, prospects for reducing mortality from this disease appear to be growing [7], whereas advances in critical care are concomitantly improving outcomes for ICU patients. These data, including specific information about outcomes of intensive care therapy for patients with lung cancer, have driven an increasing receptivity on the part of intensivists to initiate this therapy and to pursue it aggressively, at least for a time-limited trial [1,3,4,6,8]. Concerns remain, however, that the experience of the ICU for lung cancer patients and families, and their longer-term outcomes, often may be unfavorable [9].In this article, we start from the assumption that lung cancer patients will continue to be cared for in ICUs, likely with increasing frequency, in the foreseeable future [10]. We also accept the premise that all patients with critical illness, regardless of prognosis, should receive high-quality palliative care comprising the following core elements: alleviation of symptom distress; communication about care goals; alignment of treatment with patients' values and preferences; transitional planning; and support for both patient and family throughout the illness trajectory [11-14]. For our framework, we favor a concurrent model in which palliative care and intensive care are provided together as synergistic approaches, rather than a sequent