Letter to the Editor
Complexity and uncertainty in the critical care of cancer patients in the era of immunotherapy and targeted therapies
Complejidad e incertidumbre en cuidados críticos para pacientes con cáncer en la era de la inmunoterapia y terapias dirigidas
A. Carmona-Bayonasa,
, F. Gordob, C. Beatoc, J. Castaño Pérezd, P. Jiménez-Fonsecae, J. Virizuela Echaburuc, J. Garnacho-Monterof
Autor para correspondencia
a Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, Instituto Murciano de Investigación Biosanitaria (IMIB), UMU, Murcia, Spain
b Intensive Care Department, Hospital Universitario del Henares (Coslada-Madrid); Grupo de investigación en patología crítica, Facultad de Ciencias de la Salud, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain
c Medical Oncology Department, Hospital Universitario Virgen de la Macarena, Sevilla, Spain
d Intensive Care Department, Hospital Universitario Virgen de las Nieves, Granada, Spain
e Medical Oncology Department, Hospital Universitario Central de Asturias, Oviedo, Spain
f Intensive Care Department, Hospital Universitario Virgen de la Macarena, Sevilla, Spain
Leído
5142
Vecesse ha leído el artículo
2184
Total PDF
2958
Total HTML
Compartir estadísticas
array:23 [ "pii" => "S0210569118301566" "issn" => "02105691" "doi" => "10.1016/j.medin.2018.05.001" "estado" => "S300" "fechaPublicacion" => "2018-12-01" "aid" => "1217" "copyright" => "Elsevier España, S.L.U. y SEMICYUC" "copyrightAnyo" => "2018" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Med Intensiva. 2018;42:570-1" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1126 "formatos" => array:3 [ "EPUB" => 195 "HTML" => 575 "PDF" => 356 ] ] "itemSiguiente" => array:19 [ "pii" => "S0210569117302188" "issn" => "02105691" "doi" => "10.1016/j.medin.2017.07.005" "estado" => "S300" "fechaPublicacion" => "2018-12-01" "aid" => "1094" "copyright" => "Elsevier España, S.L.U. y SEMICYUC" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Med Intensiva. 2018;42:e23" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1992 "formatos" => array:3 [ "EPUB" => 195 "HTML" => 1201 "PDF" => 596 ] ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">IMÁGENES EN MEDICINA INTENSIVA</span>" "titulo" => "Embolia grasa cerebral masiva tardía secundaria a politraumatismo grave" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "e23" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Delayed massive cerebral fat embolism secondary to severe polytrauma" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1371 "Ancho" => 2333 "Tamanyo" => 203336 ] ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J. Romero-Imbroda, C. Martínez-Agudiez, S. Villanueva-Serrano" "autores" => array:3 [ 0 => array:2 [ "nombre" => "J." "apellidos" => "Romero-Imbroda" ] 1 => array:2 [ "nombre" => "C." "apellidos" => "Martínez-Agudiez" ] 2 => array:2 [ "nombre" => "S." "apellidos" => "Villanueva-Serrano" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173572718301759" "doi" => "10.1016/j.medine.2018.09.005" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572718301759?idApp=WMIE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210569117302188?idApp=WMIE" "url" => "/02105691/0000004200000009/v1_201811220619/S0210569117302188/v1_201811220619/es/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S0210569118300895" "issn" => "02105691" "doi" => "10.1016/j.medin.2018.03.001" "estado" => "S300" "fechaPublicacion" => "2018-12-01" "aid" => "1196" "copyright" => "Elsevier España, S.L.U. y SEMICYUC" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Med Intensiva. 2018;42:569-70" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1475 "formatos" => array:3 [ "EPUB" => 155 "HTML" => 924 "PDF" => 396 ] ] "es" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta al Editor</span>" "titulo" => "Cuidados intensivos de pacientes oncológicos en la era del tratamiento multidisciplinar: la perspectiva desde la oncología radioterápica" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "569" "paginaFinal" => "570" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Intensive care in cancer patients in the age of the multidisciplinary approach of cancer treatments: The radiotherapy perspective" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Illescas-Vacas, N. Abu-Omar, C. Míguez, E. Bayo-Lozano" "autores" => array:4 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Illescas-Vacas" ] 1 => array:2 [ "nombre" => "N." "apellidos" => "Abu-Omar" ] 2 => array:2 [ "nombre" => "C." "apellidos" => "Míguez" ] 3 => array:2 [ "nombre" => "E." "apellidos" => "Bayo-Lozano" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173572718301188" "doi" => "10.1016/j.medine.2018.05.012" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572718301188?idApp=WMIE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210569118300895?idApp=WMIE" "url" => "/02105691/0000004200000009/v1_201811220619/S0210569118300895/v1_201811220619/es/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Complexity and uncertainty in the critical care of cancer patients in the era of immunotherapy and targeted therapies" "tieneTextoCompleto" => true "saludo" => "Dear Editor:" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "570" "paginaFinal" => "571" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "A. Carmona-Bayonas, F. Gordo, C. Beato, J. Castaño Pérez, P. Jiménez-Fonseca, J. Virizuela Echaburu, J. Garnacho-Montero" "autores" => array:7 [ 0 => array:4 [ "nombre" => "A." "apellidos" => "Carmona-Bayonas" "email" => array:1 [ 0 => "alberto.carmonabayonas@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "F." "apellidos" => "Gordo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "C." "apellidos" => "Beato" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "J." "apellidos" => "Castaño Pérez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] 4 => array:3 [ "nombre" => "P." "apellidos" => "Jiménez-Fonseca" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "aff0025" ] ] ] 5 => array:3 [ "nombre" => "J." "apellidos" => "Virizuela Echaburu" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 6 => array:3 [ "nombre" => "J." "apellidos" => "Garnacho-Montero" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">f</span>" "identificador" => "aff0030" ] ] ] ] "afiliaciones" => array:6 [ 0 => array:3 [ "entidad" => "Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, Instituto Murciano de Investigación Biosanitaria (IMIB), UMU, Murcia, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Intensive Care Department, Hospital Universitario del Henares (Coslada-Madrid); Grupo de investigación en patología crítica, Facultad de Ciencias de la Salud, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Medical Oncology Department, Hospital Universitario Virgen de la Macarena, Sevilla, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Intensive Care Department, Hospital Universitario Virgen de las Nieves, Granada, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Medical Oncology Department, Hospital Universitario Central de Asturias, Oviedo, Spain" "etiqueta" => "e" "identificador" => "aff0025" ] 5 => array:3 [ "entidad" => "Intensive Care Department, Hospital Universitario Virgen de la Macarena, Sevilla, Spain" "etiqueta" => "f" "identificador" => "aff0030" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Complejidad e incertidumbre en cuidados críticos para pacientes con cáncer en la era de la inmunoterapia y terapias dirigidas" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We have carefully read the letter from Illescas-Vacas et al. regarding SEOM-SEMICYUC's commitment to optimize the care of cancer patients admitted to Intensive Care Units.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">1,2</span></a> We agree with the authors that radiotherapy has evolved with important technological advances in recent years, with more precise, effective and less toxic treatments that contribute to improve survival. Likewise, radiotherapy, in general, is associated with low acute potential toxicity if administered in monotherapy, without concomitant systemic treatment. On the contrary, systemic cancer treatments, chemotherapy, anti-target agents and immunotherapy, among others, have made it possible for a group of patients with advanced disease becoming long-term survivors. Nevertheless, these drugs not only bring new opportunities for patients, but also new challenges and toxicities, creating greater complexity and uncertainty in the field of critical care. In the previous decade, when the prognosis was universally bleak, decision-making was simple, the only solution often being palliative care. However, admission and support in the Intensive Care Unit of a patient with metastatic cancer may currently be justified if it is known that his tumor expresses a target for which specific treatment is available. In addition, a patient with advanced cancer who develops severe toxicity while receiving immunotherapy may require advanced supportive care if a tumor response has been confirmed. These oncological situations and emergencies, which are increasingly common nowadays, have led the SEOM-SEMICYUC team to develop an informative document in which they comment on the oncological scenarios and treatments that are most associated with an acute or emergency condition, something that is especially common in advanced cancers with systemic treatments. This paper shows the two great challenges that technology is imposing on clinical decision making: (1) to correctly transmit information between professionals on individualized prognosis, sometimes based on complex biomarkers,<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">3</span></a> (2) to assume that sometimes we will have lost our ability to identify which patients are going to be long-term survivors, so we will be required to provide many of them with adequate support.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">3,4</span></a></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0010" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflict of interest</span><p id="par0015" class="elsevierStylePara elsevierViewall">The authors state that they have no conflict of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflict of interest" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:4 [ 0 => array:3 [ "identificador" => "bib0025" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cuidados intensivos de pacientes oncológicos en la era del tratamiento multidisciplinar: la perspectiva desde la oncología radioterápica" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A. Illescas-Vacas" 1 => "N. Abu-Omar" 2 => "C. Míguez" 3 => "E. Bayo-Lozano" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Med Intensiva" "fecha" => "2018" "volumen" => "42" "paginaInicial" => "572" "paginaFinal" => "573" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0030" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Intensive care in cancer patients in the age of immunotherapy and molecular therapies: commitment of the SEOM-SEMICYUC" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Carmona-Bayonas" 1 => "F. Gordo" 2 => "C. Beato" 3 => "J. Castaño Pérez" 4 => "P. Jiménez-Fonseca" 5 => "J. Virizuela Echaburu" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:2 [ "tituloSerie" => "Med Intensiva" "fecha" => "2018" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0035" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Crizotinib in ROS1 – rearranged non-small-cell lung cancer" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A.T. Shaw" 1 => "S.-H.I. Ou" 2 => "Y.-J. Bang" 3 => "D.R. Camidge" 4 => "B.J. Solomon" 5 => "R. Salgia" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa1406766" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2014" "volumen" => "371" "paginaInicial" => "1963" "paginaFinal" => "1971" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25264305" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0040" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pembrolizumab versus docetaxel for previously treated, PD-L1-positive, advanced non-small-cell lung cancer (KEYNOTE-010): a randomised controlled trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R.S. Herbst" 1 => "P. Baas" 2 => "D.-W. Kim" 3 => "E. Felip" 4 => "J.L. Pérez-Gracia" 5 => "J.-Y. Han" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0140-6736(15)01281-7" "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "2016" "volumen" => "387" "paginaInicial" => "1540" "paginaFinal" => "1550" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26712084" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/02105691/0000004200000009/v1_201811220619/S0210569118301566/v1_201811220619/en/main.assets" "Apartado" => array:4 [ "identificador" => "57221" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Cartas al Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/02105691/0000004200000009/v1_201811220619/S0210569118301566/v1_201811220619/en/main.pdf?idApp=WMIE&text.app=https://medintensiva.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210569118301566?idApp=WMIE" ]
| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 10 | 6 | 16 |
| 2024 Octubre | 39 | 45 | 84 |
| 2024 Septiembre | 44 | 31 | 75 |
| 2024 Agosto | 44 | 38 | 82 |
| 2024 Julio | 29 | 33 | 62 |
| 2024 Junio | 55 | 45 | 100 |
| 2024 Mayo | 40 | 30 | 70 |
| 2024 Abril | 54 | 51 | 105 |
| 2024 Marzo | 40 | 24 | 64 |
| 2024 Febrero | 37 | 41 | 78 |
| 2024 Enero | 40 | 30 | 70 |
| 2023 Diciembre | 25 | 30 | 55 |
| 2023 Noviembre | 39 | 49 | 88 |
| 2023 Octubre | 29 | 21 | 50 |
| 2023 Septiembre | 26 | 38 | 64 |
| 2023 Agosto | 19 | 16 | 35 |
| 2023 Julio | 43 | 27 | 70 |
| 2023 Junio | 25 | 22 | 47 |
| 2023 Mayo | 34 | 32 | 66 |
| 2023 Abril | 35 | 20 | 55 |
| 2023 Marzo | 40 | 31 | 71 |
| 2023 Febrero | 50 | 37 | 87 |
| 2023 Enero | 33 | 23 | 56 |
| 2022 Diciembre | 50 | 40 | 90 |
| 2022 Noviembre | 36 | 45 | 81 |
| 2022 Octubre | 58 | 27 | 85 |
| 2022 Septiembre | 37 | 37 | 74 |
| 2022 Agosto | 51 | 35 | 86 |
| 2022 Julio | 35 | 40 | 75 |
| 2022 Junio | 30 | 24 | 54 |
| 2022 Mayo | 39 | 38 | 77 |
| 2022 Abril | 33 | 36 | 69 |
| 2022 Marzo | 42 | 44 | 86 |
| 2022 Febrero | 44 | 22 | 66 |
| 2022 Enero | 57 | 43 | 100 |
| 2021 Diciembre | 51 | 46 | 97 |
| 2021 Noviembre | 39 | 44 | 83 |
| 2021 Octubre | 51 | 65 | 116 |
| 2021 Septiembre | 30 | 36 | 66 |
| 2021 Agosto | 25 | 38 | 63 |
| 2021 Julio | 18 | 29 | 47 |
| 2021 Junio | 35 | 29 | 64 |
| 2021 Mayo | 51 | 46 | 97 |
| 2021 Abril | 77 | 56 | 133 |
| 2021 Marzo | 91 | 26 | 117 |
| 2021 Febrero | 73 | 22 | 95 |
| 2021 Enero | 33 | 28 | 61 |
| 2020 Diciembre | 28 | 18 | 46 |
| 2020 Noviembre | 27 | 19 | 46 |
| 2020 Octubre | 31 | 26 | 57 |
| 2020 Septiembre | 69 | 26 | 95 |
| 2020 Agosto | 74 | 18 | 92 |
| 2020 Julio | 47 | 27 | 74 |
| 2020 Junio | 35 | 25 | 60 |
| 2020 Mayo | 47 | 16 | 63 |
| 2020 Abril | 53 | 12 | 65 |
| 2020 Marzo | 27 | 15 | 42 |
| 2020 Febrero | 89 | 29 | 118 |
| 2020 Enero | 70 | 28 | 98 |
| 2019 Diciembre | 47 | 21 | 68 |
| 2019 Noviembre | 36 | 31 | 67 |
| 2019 Octubre | 54 | 27 | 81 |
| 2019 Septiembre | 60 | 32 | 92 |
| 2019 Agosto | 66 | 26 | 92 |
| 2019 Julio | 41 | 24 | 65 |
| 2019 Junio | 22 | 10 | 32 |
| 2019 Mayo | 42 | 43 | 85 |
| 2019 Abril | 31 | 25 | 56 |
| 2019 Marzo | 18 | 23 | 41 |
| 2019 Febrero | 2 | 11 | 13 |
| 2019 Enero | 3 | 10 | 13 |
| 2018 Diciembre | 9 | 17 | 26 |
| 2018 Noviembre | 12 | 8 | 20 |
| 2018 Octubre | 1 | 0 | 1 |
| 2018 Julio | 1 | 1 | 2 |
Mostrar todo
