In a study reported in the Journal of Oncology Practice, Bruckel et al found that among patients with in-hospital cardiac arrest, those with advanced cancer had lower survival rates and were more frequently designated Do Not Attempt Resuscitation (DNAR) within 48 hours after return of spontaneous circulation.
The study included identification of 47,157 adults with in-hospital cardiac arrest with and without advanced cancer (defined as metastatic or hematologic malignancy) from the Get With The Guidelines–Resuscitation registry at 369 hospitals from April 2006 through June 2010. The study population excluded patients who were in perioperative areas or certain procedural areas (eg, cardiac catheterization laboratory or interventional radiology), emergency departments, or rehabilitation areas; those with implantable cardioverter-defibrillators or an arrest duration of < 2 minutes without return of spontaneous circulation; and those who were missing pertinent demographic or event data.
Overall, 6,585 patients with in-hospital cardiac arrest (14%) had advanced cancer. Patients with advanced cancer were younger, had fewer interventions in place at the time of cardiac arrest, were less likely to be in the intensive care unit at the time of arrest, more likely to have pulseless electrical activity as the initial cardiac arrest rhythm, and more frequently treated at teaching hospitals.
Differences in Survival
Patients with advanced cancer had lower multivariate-adjusted rates of return of spontaneous circulation (52.3% vs 56.6%, relative risk [RR] = 0.93, P < .001) and survival to discharge (7.4% vs 13.4%, RR = 0.55, P < .001) compared with patients without advanced cancer. Among patients who died during resuscitation, those with advanced cancer had a better performance on most resuscitation quality measures (eg, duration of resuscitation, chest compressions within 2 minutes, defibrillation within 2 minutes for ventricular fibrillation [VF] or ventricular tachycardia [VT] patients, and adrenaline/epinephrine within 5 minutes for non-VF/non-VT patients on adjusted analysis).
Among patients with return of spontaneous circulation, those with advanced cancer were made DNAR more frequently within 48 hours (37.3% vs 27.1%, RR = 1.38, P < .001). In an analysis of survival to discharge among survivors of initial arrest, adjustment for DNAR status reduced the difference between the advanced cancer group vs the no–advanced cancer group, with the difference remaining significant (from RR = 0.61, P < .001 to RR = 0.74, P <.001, after adjustment for DNAR status).
The investigators concluded: “Patients with advanced cancer can expect lower survival rates after [in-hospital cardiac arrest] compared with those without advanced cancer, and they are more frequently made DNAR within 48 hours of [return of spontaneous circulation]. These findings have important implications for discussions of resuscitation care wishes with patients and can better inform end-of-life discussions.”
The study was supported by grants from the National Heart Lung and Blood Institute and Veterans Administration Health Services Research and Development.
Jeffrey T. Bruckel, MD, MPH, of the University of Rochester Medical Center, is the corresponding author of the Journal of Oncology Practice article.
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