Study of Interactions Between Oncologists and Resuscitators to Optimize Decision Making for Admission of Patients With Metastatic Solid Cancer to the ICU (InterOncoRea)

NCT ID: NCT06993987

Last Updated: 2025-05-29

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

ACTIVE_NOT_RECRUITING

Total Enrollment

139 participants

Study Classification

OBSERVATIONAL

Study Start Date

2025-03-01

Study Completion Date

2025-10-31

Brief Summary

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The aim of our study is to optimise the interaction between oncologists and resuscitators to improve decision-making regarding the admission of patients with metastatic solid cancers to the ICU.

The study is structured into two successive stages. The first stage involves a retrospective descriptive analysis of patients with metastatic solid cancer admitted to the ICU, to enable comparison with centres that have already documented this subject.

The second stage involves personalised interviews with medical staff working in both the oncology department and the intensive care unit.

Detailed Description

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In the vast majority of cases, there is no cure for metastatic solid cancer. As a result, the question of end of life is very often present.

End of life may be linked to the aggressiveness of the disease, to therapeutic damage, but also to an independent acute event that may occur during the course of oncology care.

This explains why the question of resuscitation management comes into play in the care of our oncology patients.

The literature shows that one in 7 patients admitted to intensive care in Europe has a history of cancer, and that 5 to 10% of cancer patients will require intensive care during their course of treatment.

The therapeutic advances brought about by immunotherapy in the first instance, followed by targeted therapies in a second phase, have considerably altered the prognosis of patients with solid cancers, including the most aggressive cancers.

However, given the poor prognosis of these diseases, having metastatic cancer continues to hinder a patient's possible admission to the intensive care unit.

The second most common reason for refusing admission to the ICU is having cancer.

Yet the post-ICU mortality rate for cancer patients is identical to that of the entire ICU patient group.

Various scores have been used to determine the 'right' criteria for ICU admission for patients with metastatic solid cancers.

Nevertheless, nothing appears to be more effective than communication between oncologists and intensive care physicians, particularly since the prognosis of patients with advanced cancers is still a subject of interdisciplinary discussion.

Various scores have attempted to establish the 'right' criteria for admitting patients with metastatic solid cancers to intensive care.

However, nothing appears more effective than discussions between oncologists and resuscitators, particularly given that the prognosis of patients with advanced cancers is still a topic of interdisciplinary debate.

Indeed, the decision to admit a patient with metastatic cancer to an intensive care unit appears to raise ethical, medical and organisational issues.

Bearing this in mind, and given the numerous studies already conducted in this area, we thought it would be interesting to examine the relationship between oncology and intensive care units.

To study the interactions between intensive care physicians and oncologists and identify areas for improvement in patient care, we devised a two-stage approach.

First, we conducted personalised semi-structured interviews with doctors from the medical oncology department (oncologists, organ specialists and general practitioners) and doctors from the intensive care unit. This allowed us to identify the obstacles that each speciality faces when admitting a patient to the intensive care unit. This would enable us to deduce the elements essential for reaching an agreement on admitting a patient to the intensive care unit (Stage 1).

Secondly, we will review practices at Brest University Hospital (and possibly other centres that might be interested in our work) and compare them with data in the literature to see if our decisions are similar to those made in other centres that have already documented the subject (Stage 2).

Conditions

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Intensive Care Unit (ICU) Patients Metastatic Cancer

Study Design

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Observational Model Type

COHORT

Study Time Perspective

RETROSPECTIVE

Study Groups

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Patients with metastatic solid cancer admitted to the ICU

Descriptive analysis

Intervention Type OTHER

The descriptive analysis of qualitative variables (reason for admission) will be carried out in the form of frequencies and percentages. Quantitative variables will be described in terms of averages, medians or standard deviations, as required.

Interventions

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Descriptive analysis

The descriptive analysis of qualitative variables (reason for admission) will be carried out in the form of frequencies and percentages. Quantitative variables will be described in terms of averages, medians or standard deviations, as required.

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Major patient hospitalized in medical or surgical intensive care with metastatic solid cancer, whatever the primary site and whatever the reason for admission to the intensive care unit
* Start of stay in intensive care must be between June 1, 2023 and June 1, 2024.

Exclusion Criteria

* Patient objecting to data processing
* The patient is under legal protection (e.g. guardianship or curatorship)
* A patient with multiple synchronous cancers
* Diagnosis of metastatic cancer during stay in intensive care unit intensive care unit
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University Hospital, Brest

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Locations

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Chu Brest

Brest, , France

Site Status

Countries

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France

References

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Iapichino G, Corbella D, Minelli C, Mills GH, Artigas A, Edbooke DL, Pezzi A, Kesecioglu J, Patroniti N, Baras M, Sprung CL. Reasons for refusal of admission to intensive care and impact on mortality. Intensive Care Med. 2010 Oct;36(10):1772-1779. doi: 10.1007/s00134-010-1933-2. Epub 2010 Jun 9.

Reference Type RESULT
PMID: 20533023 (View on PubMed)

Robert R, Reignier J, Tournoux-Facon C, Boulain T, Lesieur O, Gissot V, Souday V, Hamrouni M, Chapon C, Gouello JP; Association des Reanimateurs du Centre Ouest Group. Refusal of intensive care unit admission due to a full unit: impact on mortality. Am J Respir Crit Care Med. 2012 May 15;185(10):1081-7. doi: 10.1164/rccm.201104-0729OC. Epub 2012 Feb 16.

Reference Type RESULT
PMID: 22345582 (View on PubMed)

Padhi S, Shrestha P, Alamgeer M, Stevanovic A, Karikios D, Rajamani A, Subramaniam A. Oncology and intensive care doctors' perception of intensive care admission of cancer patients: A cross-sectional national survey. Aust Crit Care. 2024 Jul;37(4):520-529. doi: 10.1016/j.aucc.2023.12.005. Epub 2024 Feb 12.

Reference Type RESULT
PMID: 38350752 (View on PubMed)

Nassar AP Jr, Dettino ALA, Amendola CP, Dos Santos RA, Forte DN, Caruso P. Oncologists' and Intensivists' Attitudes Toward the Care of Critically Ill Patients with Cancer. J Intensive Care Med. 2019 Oct;34(10):811-817. doi: 10.1177/0885066617716105. Epub 2017 Jul 5.

Reference Type RESULT
PMID: 28675982 (View on PubMed)

Toffart AC, Gonzalez F, Hamidfar-Roy R, Darrason M. [ICU admission for cancer patients with respiratory failure: An ethical dilemma]. Rev Mal Respir. 2023 Oct;40(8):692-699. doi: 10.1016/j.rmr.2023.07.003. Epub 2023 Aug 31. French.

Reference Type RESULT
PMID: 37659881 (View on PubMed)

Borcoman E, Dupont A, Mariotte E, Doucet L, Joseph A, Chermak A, Valade S, Resche-Rigon M, Azoulay E, Lemiale V. One-year survival in patients with solid tumours discharged alive from the intensive care unit after unplanned admission: A retrospective study. J Crit Care. 2020 Jun;57:36-41. doi: 10.1016/j.jcrc.2020.01.027. Epub 2020 Jan 30.

Reference Type RESULT
PMID: 32032902 (View on PubMed)

Gwilliam B, Keeley V, Todd C, Roberts C, Gittins M, Kelly L, Barclay S, Stone P. Prognosticating in patients with advanced cancer--observational study comparing the accuracy of clinicians' and patients' estimates of survival. Ann Oncol. 2013 Feb;24(2):482-488. doi: 10.1093/annonc/mds341. Epub 2012 Oct 1.

Reference Type RESULT
PMID: 23028038 (View on PubMed)

Miller KD, Nogueira L, Devasia T, Mariotto AB, Yabroff KR, Jemal A, Kramer J, Siegel RL. Cancer treatment and survivorship statistics, 2022. CA Cancer J Clin. 2022 Sep;72(5):409-436. doi: 10.3322/caac.21731. Epub 2022 Jun 23.

Reference Type RESULT
PMID: 35736631 (View on PubMed)

Bos MM, Verburg IW, Dumaij I, Stouthard J, Nortier JW, Richel D, van der Zwan EP, de Keizer NF, de Jonge E. Intensive care admission of cancer patients: a comparative analysis. Cancer Med. 2015 Jul;4(7):966-76. doi: 10.1002/cam4.430. Epub 2015 Apr 18.

Reference Type RESULT
PMID: 25891471 (View on PubMed)

Puxty K, McLoone P, Quasim T, Sloan B, Kinsella J, Morrison DS. Risk of Critical Illness Among Patients With Solid Cancers: A Population-Based Observational Study. JAMA Oncol. 2015 Nov;1(8):1078-85. doi: 10.1001/jamaoncol.2015.2855.

Reference Type RESULT
PMID: 26313462 (View on PubMed)

Taccone FS, Artigas AA, Sprung CL, Moreno R, Sakr Y, Vincent JL. Characteristics and outcomes of cancer patients in European ICUs. Crit Care. 2009;13(1):R15. doi: 10.1186/cc7713. Epub 2009 Feb 6.

Reference Type RESULT
PMID: 19200368 (View on PubMed)

Other Identifiers

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29BRC25.0045 - InterOncoRea

Identifier Type: -

Identifier Source: org_study_id

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