Yoğun Bakım Ünitelerinde Kanser Hastalarının Prognozu
Özet
Tüm dünyada kanser tanısı alan hasta sayısının artmasıyla birlikte, geliştirilen yeni tedaviler sayesinde kanser hastalarının yaşam süreleri uzamakta ve buna bağlı olarak bu hastalar yoğun bakım ünitelerinde (YBÜ) daha sık takip edilmektedir. Kanser hastalarının YBÜ'ye en yaygın yatış nedenleri arasında ventilasyon gerektiren akut solunum yetmezliği, böbrek yetmezliği ve septik şok yer almaktadır. Hastaların kısa dönem mortalitesinde, altta yatan kanserin özelliklerinden ziyade akut hastalığın etiyolojisi, ciddiyeti ve organ yetmezliğinin sayısı daha belirleyicidir. Özellikle mekanik ventilatöre bağlı olanlarda, ikiden fazla organ yetmezliği (MODS) bulunanlarda ve allojenik hematopoetik hücre nakli (HHN) alıcılarında ölüm oranları oldukça yüksektir. Hematolojik malignitesi olan hastalarda, enfeksiyon riskinin ve solunum yetmezliğinin daha sık görülmesi nedeniyle solid tümörlere kıyasla uzun dönem mortalite daha yüksek seyretmektedir. Ayrıca derin nötropeni ve immunsupresyon nedeniyle bu hastalarda sepsis ve invaziv fungal enfeksiyonlar (Aspergillus ve Candida) hayatı tehdit eden önemli prognostik faktörlerdir. Hastaların takibinde APACHE ve SOFA gibi skorlama sistemleri kullanılsa da bunlar kanser hastalarında bazen yetersiz kalabilmektedir. Sonuç olarak, yüksek riskli bu hastaların prognozunu optimize etmek adına hematologlar, onkologlar ve yoğun bakım hekimleri arasında yakın bir iş birliği yapılması ve prognozun sık aralıklarla yeniden değerlendirilmesi büyük önem taşımaktadır.
With the increasing number of patients diagnosed with cancer worldwide, the survival rates of cancer patients are extending thanks to newly developed treatments, leading to more frequent follow-ups in intensive care units (ICUs). The most common reasons for admitting cancer patients to the ICU include acute respiratory failure requiring ventilation, renal failure, and septic shock. In terms of short-term mortality, the etiology and severity of the acute illness, as well as the number of organ failures, are more decisive than the characteristics of the underlying cancer. Mortality rates are particularly high in patients dependent on mechanical ventilation, those with more than two organ failures (MODS), and allogeneic hematopoietic cell transplant (HCT) recipients. Due to the more frequent occurrence of infection risks and respiratory failure, long-term mortality is higher in patients with hematological malignancies compared to those with solid tumors. Furthermore, due to prolonged neutropenia and immunosuppression, sepsis and invasive fungal infections (Aspergillus and Candida) serve as critical life-threatening prognostic factors in these patients. Although scoring systems like APACHE and SOFA are utilized in patient follow-ups, they may sometimes fall short in predicting mortality specifically for cancer patients. Consequently, to optimize the prognosis of these high-risk patients, close cooperation among hematologists, oncologists, and intensive care physicians, alongside frequent re-evaluations of prognosis, is of paramount importance.
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