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Letter to the Editor
Multidisciplinary rounds in oncology and hematology: Are they superior to rapid response teams?
Rondas multidisciplinares en oncología y hematología: ¿son superiores a los equipos de respuesta rápida?
A. García-de-Lorenzoa,b,
Corresponding author
agdl@telefonica.net

Corresponding author.
, V. Jiménezc, J. Feliud, M.J. Asensioa, B. Civantosa, J.M. Añóna,e
a Servicio de Medicina Intensiva, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain
b Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain
c Servicio de Hematología, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain
d Servicio de Oncología Médica, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain
e CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III (ISCIII), Madrid, Spain
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        "titulo" => "Rondas multidisciplinares en oncolog&#237;a y hematolog&#237;a&#58; &#191;son superiores a los equipos de respuesta r&#225;pida&#63;"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Over the last few years&#44; the therapeutic armamentarium for the management of neoplasms has experienced a tremendous growth&#46; Actually&#44; it is associated with an exponentially increasing number of patients who require advanced therapies including life support due to infections-sepsis&#44; respiratory failure&#44; neurological disorders and&#47;or complications associated with chemotherapy&#46; As a matter of fact&#44; we should accept the fact that this is a process on the rise&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Fifteen per cent of hematological patients require admission to the intensive care unit &#40;ICU&#41; due to their clinical condition&#46; Also&#44; these admissions are associated with iso-severity criteria being the number of patients with solid tumors admitted for medical reasons relatively low compared to those admitted to recovery rooms&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Azoulay et al&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> confirm an increasing number of oncological and hematological patients admitted to the ICU&#8212;representative of an up to 15&#37; occupation rate&#8212;and a higher survival rate both for the ICU &#40;mortality rate &#60; 30&#37;&#41; and the hospital &#40;mortality rate &#60; 40&#37;&#41;&#46; Regarding hematological patients&#44; more patients admitted to the ICU are in remission and have a better quality of life compared to patients who were never admitted in the first place&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Our former &#40;2000&#8722;11&#41; and later data &#40;2012&#8722;16&#41; on the implementation of daily multidisciplinary rounds in the onco-hematological unit show higher rates of admission &#40;8&#37;&#41; to the ICU and lower mortality rates at the ICU setting both at the 90-day follow-up and after 90 days &#40;44&#37;&#44; 54&#37;&#44; and 62&#37;&#41; compared to the pre-implementation period of these rounds &#40;53&#37;&#44; 61&#37;&#44; and 66&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> We believe that these multidisciplinary rounds may outperform the rapid response teams including daily assessments at the hospital floor&#44; monitorization and administration of advanced therapies &#40;high flow&#44; fluids&#44; antibiotics&#44; vasopressors&#8230;&#41;&#44; decisions on the patient&#8217;s admission and how early it should occur&#44; and the therapeutic targets that should be reached &#40;non-invasive and invasive ventilation&#44; ECMO&#44; CVHH&#46; However&#44; stable and uncompromised patients who are going to receive some kind of life-threatening therapy &#40;CAR T cell therapy&#58; ARDS&#44; shock&#8230;&#41; can also be admitted to the ICU&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Finally&#44; the key points that should be observed in the partnerships achieved among different units are<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>&#58; <ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#8226;</span><p id="par0025" class="elsevierStylePara elsevierViewall">Specific clinical practice guidelines for ICU admission and therapeutic protocols before and after admission should become available &#40;actually they are already available in 79&#37; 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immunotherapies&#44; and biotherapies&#46;</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">&#8226;</span><p id="par0060" class="elsevierStylePara elsevierViewall">Implement the QALY &#40;quality-adjusted life years&#41; score&#46;</p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">&#8226;</span><p id="par0065" class="elsevierStylePara elsevierViewall">Take into account the family&#8217;s specific needs&#46;</p></li><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">&#8226;</span><p id="par0070" class="elsevierStylePara elsevierViewall">Encourage multidisciplinary cooperation&#46;</p></li><li class="elsevierStyleListItem" id="lsti0055"><span class="elsevierStyleLabel">&#8226;</span><p id="par0075" class="elsevierStylePara elsevierViewall">Cost assessment&#46;</p></li><li class="elsevierStyleListItem" id="lsti0060"><span class="elsevierStyleLabel">&#8226;</span><p id="par0080" class="elsevierStylePara elsevierViewall">Consider the added value of an ICU-oncological setting&#46;</p></li></ul></p></span>"
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Article information
ISSN: 21735727
Original language: English
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