Patients who have advanced cancer and suffer cardiac arrest while in the hospital have a survival rate of less than 10 percent, half that of patients who have a heart attack but do not have cancer, a new study suggests.
“We’re hopeful that our study in some way will help doctors and cancer patients make more informed decisions about the end of life…”
The data help to clear up some myths in medicine about cardiac arrest survival and can be used as a guidepost when hospitalized cancer patients and their families consider do-not-resuscitate (DNR) orders, says Jeffrey T. Bruckel, a third-year postdoctoral fellow in cardiology at the University of Rochester Medical Center, who led the research.
“We’re hopeful that our study in some way will help doctors and cancer patients make more informed decisions about the end of life,” Bruckel says. “It’s very important to have early, frank, discussions around the goals of care.”
Researchers used a nationwide resuscitation registry to evaluate survival after cardiac arrest of more than 47,000 people at 369 hospitals. They excluded patients who were in for surgery (before, during, and after), emergency room treatment, rehabilitation, or treatment from cardiac catheterization labs or interventional radiology, as well as patients with implantable defibrillators from the study.
Of the 47,157 patients who experienced cardiac arrest, 6,585 or 14 percent had advanced cancer at the time of the arrest.
Researchers also looked at how resuscitation efforts occurred. Another myth in medicine is that patients with advanced cancer receive less aggressive resuscitation care, but researchers found no evidence of that happening, Bruckel says.
In fact, the average time that doctors worked to resuscitate all patients (cancer and non-cancer) ranged from about 22 to 24 minutes, the study showed.
However, after cancer patients were successfully resuscitated, they more often signed DNR orders during the next 48 hours.
When outcomes of cancer and non-cancer patients were compared, results showed that 57.5 percent of the cancer patients were resuscitated successfully but only 9.6 percent survived to be discharged from the hospital; whereas 63 percent of the non-cancer patients were successfully resuscitated and 19.2 percent survived to the time of discharge.
Researchers reported several limitations to the study, including a lack of detailed data on the types of advanced cancer and cancer treatments being given used at the time of cardiac arrest.
The study appears in the Journal of Oncology Practice. Additional researchers contributing to the study are from the University of Michigan, the Dartmouth-Hitchcock Medical Center, St. Luke’s Mid-America Heart Institute, the University of Missouri-Kansas City, and the Minneapolis Heart Institute.
The National Heart Lung and Blood Institute and the Veterans Administration funded the study.
Source: University of Rochester