Prevalence of resuscitation in cancer patients at the end of life—a population-based observational study from Germany

Dasch, Burkhard; Lenz, Philipp; Zahn, Peter

doi:10.21037/apm-20-1208

Cited by 2 publications

(2 citation statements)

References 28 publications

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“…13,30 Third, the indicators we chose might be viewed as subjective; however, very similar parameters were found to be associated with poor outcomes when used in the assessment of ICU admission for hematologic malignancy. [31][32][33] Fourth, due to the retrospective nature, an indicator such as last cancer intervention to CPR may have limited utility, because clinicians likely will not know precisely when CPR will occur. Finally, we were unable to collect neurologic outcomes in our study.…”

Section: Discussionmentioning

confidence: 99%

Indicators of Clinical Trajectory in Patients With Cancer Who Receive Cardiopulmonary Resuscitation

Chawla

Gutiérrez

Rajendram

et al. 2023

Journal of the National Comprehensive Cancer Network

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Background: Patients with cancer who require cardiopulmonary resuscitation (CPR) historically have had low survival to hospital discharge; however, overall CPR outcomes and cancer survival have improved. Identifying patients with cancer who are unlikely to survive CPR could guide and improve end-of-life discussions prior to cardiac arrest. Methods: Demographics, clinical variables, and outcomes including immediate and hospital survival for patients with cancer aged ≥18 years who required in-hospital CPR from 2012 to 2015 were collected. Indicators capturing the overall declining clinical and oncologic trajectory (ie, no further therapeutic options for cancer, recommendation for hospice, or recommendation for do not resuscitate) prior to CPR were determined a priori and manually identified. Results: Of 854 patients with cancer who underwent CPR, the median age was 63 years and 43.6% were female; solid cancers accounted for 60.6% of diagnoses. A recursive partitioning model selected having any indicator of declining trajectory as the most predictive factor in hospital outcome. Of our study group, 249 (29%) patients were found to have at least one indicator identified prior to CPR and only 5 survived to discharge. Patients with an indicator were more likely to die in the hospital and none were alive at 6 months after discharge. These patients were younger (median age, 59 vs 64 years; P≤.001), had a higher incidence of metastatic disease (83.0% vs 62.9%; P<.001), and were more likely to undergo CPR in the ICU (55.8% vs 36.5%; P<.001) compared with those without an indicator. Of patients without an indicator, 145 (25%) were discharged alive and half received some form of cancer intervention after CPR. Conclusions: Providers can use easily identifiable indicators to ascertain which patients with cancer are at risk for death despite CPR and are unlikely to survive to discharge. These findings can guide discussions regarding utility of resuscitation and the lack of further cancer interventions even if CPR is successful.

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Section: Discussionmentioning

confidence: 99%

Indicators of Clinical Trajectory in Patients With Cancer Who Receive Cardiopulmonary Resuscitation

Chawla

Gutiérrez

Rajendram

et al. 2023

Journal of the National Comprehensive Cancer Network

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“…A previous study of cardiac arrest among patients with cancer found that resuscitated patients with palliative care are younger than patients with cancer without palliative care, which could be another factor to explain the age difference. 22 It should be stressed that only OHCA cases with initiated CPR are included in this study.…”

Section: Discussionmentioning

confidence: 99%

Poorer survival after out-of-hospital cardiac arrest among cancer patients: a population-based register study

Hägglund

Jonsson

Hedayati

et al. 2023

European Heart Journal: Acute Cardiovascular Care

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Background and Aims The association between cancer and survival after out-of-hospital cardiac arrest (OHCA) has not been thoroughly investigated. We aimed to address this knowledge gap using national, population-based registries. Methods For this study, 30,163 OHCA patients (≥18 years) were included from the Swedish Register of Cardiopulmonary Resuscitation. Via linkage to the National Patient Registry, 2,894 patients (10%) with cancer diagnosed within 5 years prior to OHCA were identified. Differences in 30-day survival between cancer patients and controls (defined as OHCA patients without previous cancer diagnosis) were assessed related to cancer stage (locoregional vs metastasized cancer) and cancer site (i.e. lung cancer, breast cancer etc.) using logistic regression adjusted for prognostic factors. Long-term survival is presented as a Kaplan-Meier curve. Results For locoregional cancer no statistically significant difference in return of spontaneous circulation (ROSC) was seen compared to controls, metastasized disease was associated with poorer chance of ROSC. Cancer was associated with lower 30-day survival for all cancers (Adjusted odds ratio, OR, 0.57, CI 0.49-0.66), locoregional cancer (Adjusted OR 0.68, CI 0.57-0.82) and metastasized cancer (Adjusted OR 0.24, CI 0.14-0.40) compared to controls. Lower 30-day survival compared to controls was seen for lung cancer, gynaecological and haematological cancers. Conclusion Cancer is associated with poorer 30-day survival after OHCA. This study suggests that cancer site and disease stage are more relevant factors than cancer in general with regard to its effect on survival after OHCA.

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Prevalence of resuscitation in cancer patients at the end of life—a population-based observational study from Germany

Cited by 2 publications

References 28 publications

Indicators of Clinical Trajectory in Patients With Cancer Who Receive Cardiopulmonary Resuscitation

Indicators of Clinical Trajectory in Patients With Cancer Who Receive Cardiopulmonary Resuscitation

Poorer survival after out-of-hospital cardiac arrest among cancer patients: a population-based register study

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