Impact of intensive care unit admission on the resumption of treatment in patients with cancer: a systematic review and meta-analysis.

Patients with cancer represent a substantial and growing proportion of the ICU population. Although short-term survival has improved, it remains unclear how often anticancer treatment is resumed after critical illness. We aimed to synthesize the available evidence on treatment resumption following ICU discharge in adult patients with cancer. We searched PubMed, Embase, Scopus, and Web of Science from inception to February 24, 2025 (PROSPERO CRD420251080476). We included studies reporting resumption of systemic anticancer treatment after unplanned ICU admission in adults with solid or hematological malignancies. The primary outcome was the proportion of patients resuming any anticancer treatment after discharge. The secondary outcome was resumption of the originally planned treatment. Twenty studies encompassing 3,551 patients were included. Fifteen studies encompassed patients with solid cancer (N = 1800), three patients with hematological cancer (N = 261), and two included both solid and hematological malignancies (N = 1490). Two studies were multicenter. The pooled rate of resuming any anticancer treatment after discharge was 61% (95% CI, 51-70%), with substantial heterogeneity (I2 = 95.6%). Resumption rates were 60% (95% CI, 48-71%) in patients with solid tumors and 77% (95% CI, 56-89%) in patients with hematological malignancies. Eight studies (1,736 patients) assessed resumption of the original planned regimen, with a pooled rate of 48% (95% CI, 36-60%) at 6 months post-discharge. Most patients surviving ICU admission resume anticancer therapy, but fewer than half continue their originally planned treatment. ICU admission may represent a turning point in the oncologic trajectory, highlighting the need for early post-ICU reassessment of disease status, functional capacity, and patient preferences. However, there is a lack of prospective multicenter studies with standardized definitions of treatment resumption and predefined assessment time points.