Survival at what cost? Redefining quality of life at the crossroads of tumor lysis syndrome and curative therapy
Keywords:
CALIDAD DE VIDA; ÉTICA MÉDICA; IATROGENIA; ONCOLOGÍA; SÍNDROME DE LISIS TUMORAL. , QUALITY OF LIFE; ÉTICA MÉDICA; IATROGENIC; ONCOLOGY; TUMOR LYSIS SYNDROME.Abstract
Introduction: Tumor lysis syndrome is an iatrogenic and potentially fatal metabolic emergency triggered by the massive death of tumor cells due to effective oncologic therapies. Its incidence is heterogeneous, with mortality reaching up to 79 % in acute myeloid leukemia, and it has reemerged with the introduction of new therapies such as venetoclax and immunotherapies, raising ethical dilemmas about the balance between cure and risk.
Objective: To describe the ethical dilemmas that arise at the intersection between oncologic cure and tumor lysis syndrome.
Methods: A literature review was conducted from September to October 2025 in SciELO, PubMed, and Google Scholar. Twenty-four references published between 2020–2025 were included, focusing on tumor lysis syndrome, its ethical dilemmas, harms, and therapeutic conflicts. Studies that did not clarify the severity and fatality of the syndrome or its bioethical aspects in these vulnerable patients were excluded.
Development: Tumor lysis syndrome represents a paradox in which therapeutic efficacy can precipitate severe complications, including acute renal failure and metabolic disturbances. Ethical conflicts were identified in patient autonomy, disparities in access to optimal prophylaxis, and emerging complications from preventive treatments.
Conclusions: Tumor lysis syndrome encapsulates a fundamental dilemma in modern oncology, where the pursuit of remission may compromise both quality of life and survival. It is concluded that it is imperative to develop management strategies based on individualized risk stratification, early incorporation of palliative care, and shared decision-making that prioritize both survival and quality of life.
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