Articol susținut de S.N.O.M.R.

Ioana Roxana Codru 1,2 and Liliana Vecerzan 1,3,*

1. Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; ioanaroxana.bera@ulbsibiu.ro
2. Anesthesia and Intensive Care Department, Clinical Emergency Hospital of Sibiu, 550245 Sibiu, Romania
3. Oncology Department, Clinical Military Emergency Hospital of Sibiu, 550024 Sibiu, Romania
* Correspondence: liliana.novac@ulbsibiu.ro

Cancers 2025, 17, 3636

DOI: https://doi.org/10.3390/cancers17223636

Abstract:
The intersection between oncology and intensive care has shifted from predominantly end-of-life care to a therapeutic bridge that can preserve anticancer trajectories in carefully selected patients. Yet, criteria separating benefit from futility remain fragmented.
Objective:
This paper seeks to map contemporary evidence (2015–2025) on outcomes after Intensive Care Unit (ICU) admission in adults with cancer and to identify clinical constellations in which ICU-level care still changes prognosis.
Methods:
PRISMA-ScR scoping review (PCC framework). PubMed search (2015–2025), dual screening, standardized extraction; narrative/thematic synthesis across six clusters (hematologic, solid tumors, sepsis/non-COVID-19 infection, COVID-19/viral pneumonia, novel/targeted-therapy toxicities, end-of-life/aggressive ICU) were used. No metaanalysis given heterogeneity.
Results:
Seventy-three studies (>170,000 ICU admissions) were included, mostly cohort designs across 27 countries. ICU mortality ranged 8–72% (weighted mean ≈ 41%); hospital ≈ 38%; 90-day ≈ 46%; 1-year ≈ 62%. About one third of ICU survivors resumed systemic therapy. Benefit concentrated in early admissions, single-organ failure, controlled/remission disease, postoperative/elective monitoring, and reversible treatment-related toxicities (e.g., ICI pneumonitis, CAR-T CRS/ICANS). Futility clustered around ≥3 organ supports, RRT > 7 days, refractory/progressive disease, and ECOG ≥ 3. Sepsis outcomes averaged 45–55% ICU mortality but improved with rapid recognition and source control; COVID-19 mortality was particularly high in hematologic malignancies early in the pandemic, with subsequent declines post-vaccination.
Conclusions:
In modern oncologic practice, ICU care changes prognosis when the acute physiological insult is reversible and cancer control remains plausible; conversely, high organ-support burden and refractory disease define practical futility thresholds. These signals support time-limited ICU trials, earlier ICU involvement for sepsis/irAEs, and embedded palliative care to align intensity with goals.