{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T09:49:09Z","timestamp":1791452949300,"version":"4.3.3"},"reference-count":55,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T00:00:00Z","timestamp":1791072000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T00:00:00Z","timestamp":1791072000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>The number of patients with solid tumours requiring intensive care is increasing as cancer survival improves and oncological treatments become more complex. Intensive care unit (ICU) admission decisions should not be based on cancer diagnosis, metastatic status or palliative treatment intent alone. This narrative review presents a practical, multidisciplinary framework for assessing critically ill patients with solid tumours. It integrates acute illness severity and reversibility, organ failure, baseline performance status and frailty, cancer trajectory, remaining treatment options, expected functional recovery and patient preferences. We discuss contemporary anticancer treatment toxicities, cancer-associated thromboembolic disease, older adults, palliative care, communication and ethical decision-making. We also propose an algorithm ranging from full ICU support to a time-limited ICU trial with predefined reassessment or comfort-focused care. Early joint assessment by oncology and intensive care teams, followed by dynamic reassessment, may reduce both inappropriate escalation and premature exclusion from potentially beneficial organ support. Future research should prioritize structured pathways, improved prognostic tools and outcomes beyond survival, including functional recovery, quality of life and the ability to resume meaningful cancer treatment.<\/jats:p>","DOI":"10.3390\/cancers18193210","type":"journal-article","created":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T10:02:27Z","timestamp":1791194547000},"page":"3210","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Intensive Care in Patients with Solid Tumours: A Practical Framework for Integrated Onco-Critical Care"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6075-2173","authenticated-orcid":false,"given":"Alicia","family":"Castelo-Loureiro","sequence":"first","affiliation":[{"name":"Department of Medical Oncology, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8397-4844","authenticated-orcid":false,"given":"Amanda","family":"Lesmes Gonz\u00e1lez de Aledo","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Medicine, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6628-3777","authenticated-orcid":false,"given":"Mateo","family":"Bover Larroya","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-3060-462X","authenticated-orcid":false,"given":"Zaira","family":"Molina Collado","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Medicine, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-2710-6423","authenticated-orcid":false,"given":"Cristina","family":"Serrano G\u00f3mez","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7024-1331","authenticated-orcid":false,"given":"Isa\u00edas","family":"Mart\u00edn Bad\u00eda","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Medicine, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3858-7508","authenticated-orcid":false,"given":"Jes\u00fas","family":"Gonz\u00e1lez Olmedo","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-7027-3110","authenticated-orcid":false,"given":"Santiago","family":"Ter\u00e1n","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0533-6211","authenticated-orcid":false,"given":"Marcos","family":"Valiente Fern\u00e1ndez","sequence":"additional","affiliation":[{"name":"Hospital Ruber Juan Bravo, 28006 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3719-6233","authenticated-orcid":false,"given":"Carlos","family":"Heredia-Mena","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain"},{"name":"Co-Management Working Group, Sociedad Espa\u00f1ola de Medicina Interna, 28016 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-4401-4239","authenticated-orcid":false,"given":"Joseph","family":"Exebio-Jara","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lidia","family":"Orej\u00f3n Garc\u00eda","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Medicine, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda","family":"Carnevali Fr\u00edas","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Medicine, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos","family":"G\u00f3mez 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