Prognosis Remains Poor for Patients With Cancer Undergoing CPR

November 21, 2018

By Brian Hoyle

SAN DIEGO -- November 20, 2018 -- The prognosis remains poor for cancer patients undergoing cardiopulmonary resuscitation (CPR), researchers reported here at the 2018 Palliative and Supportive Care in Oncology Symposium.

“A significant proportion of patients who survive CPR will become do-not-resuscitate (DNR) postcode,” wrote Dana Giza, MD, University of Texas M. D. Anderson Cancer Center, Houston, Texas, and colleagues in their presentation. “Physicians should effectively and honestly engage in discussing end of life matters with their cancer patients.”

CPR after cardiac arrest in patients with cancer is associated with lower survival rates when compared with patients without cancer. The quality of life of those who survive after CPR to be discharged is often diminished. Among these patients there is a high likelihood of changing their code status to DNR.

For the current study, the researchers analysed 396 DNR codes for patients treated at MD Anderson between 2017 and 2018. Just over half (53%) of the codes were triggered by a cardiopulmonary arrest, followed by respiratory distress (16%) or other causes. For more than 90% of the patients, data on average chest compression rate, average compression rate, average compression depth, and overall compression in the targeted zone indicated that the delivery of CPR had been successful, according to the criteria of the American Heart Association.

At first, CPR was a lifesaver for 79% of the patients; however, the good news was brief because 24 hours later, the survival rate was 48% and only 17% of the patients lived to be discharged. Of those who died, the pre-arranged DNR request was carried out for 253 (64%) patients.

The majority (66%) of the 396 patients were older adults (50-75 years) and had most (60%) had been diagnosed with breast, gastrointestinal, or head & neck cancer. The remaining 40% had been diagnosed with leukaemia or lymphoma or had received a stem cell transplant.

“Patients with terminal health conditions need information on the expected course of their disease and accurate prognostic information regarding both survival and quality of life after CPR in order to make informed end-of-life decisions,” the authors concluded.

[Presentation title: Impact of Cardiopulmonary Resuscitation (CPR) on the Survival of Patients With Cancer: DNR Before or After Cardiac Arrest? Abstract 71]