Cardiopulmonary resuscitation inpatient outcomes in cancer patients in a large community hospital.

BACKGROUND: Patients and clinicians have unrealistic expectations when it comes to cardiopulmonary resuscitation (CPR). Only a small percentage of patients survive a cardiopulmonary arrest and those that do live, still have a high likelihood of dying in the hospital. The quality of life for those patients who do survive to discharge is often severely diminished. For cancer patients, the statistics may be even worse. OBJECTIVE: To determine and compare the rate of survival of adult patients, with and without malignancy, after undergoing in-hospital cardiopulmonary resuscitation. The purpose of obtaining this data is to provide clinicians with tools to effectively and honestly discuss expectations concerning end of life issues with cancer patients. METHODS: A retrospective medical record review from a single large community hospital involved 154 adult patients (> or = 18 years of age) who had undergone an in-patient cardiopulmonary arrest from October 1999 to October 2011 on a combined medical oncology/medical nursing unit. The patients were divided into two groups: those with a known active malignancy and those without cancer. The groups were further categorized by various characteristics. The end points included the number of survivors at day 0 and day 30 after CPR. RESULTS: There were a total of 94 cancer patients and 60 non-cancer patients. The cancer patients were subdivided into those with solid tumors (63 patients) versus those with hematological malignancy (31 patients). The solid tumor group was further divided into localized (23 patients) and metastatic (40 patients) disease. The cancer patients were also divided by age, those 65 and older (37 patients) and those less than 65 years of age (57 patients). The non-cancer group was similarly divided into 65 and older (38 patients) and younger than 65 (22 patients). In total 16 percent of all cancer patients were alive at day 30 compared to 23 percent of non-cancer patients (p = 0.167). With respect to solid vs. hematologic tumors, both had a survival rate of 16 percent at 30 days. When comparing age differences, the younger non-cancer patients had better outcomes (27 percent survival rate) compared with younger oncology patients (18 percent). There was not a significant difference in survival between the older patients in either group. CONCLUSION: Overall the rate of survival of cancer patients in a community hospital after undergoing CPR is similar to what is described in the recent literature. The prognosis remains poor for cancer patients undergoing CPR. Therefore, clinicians should and are now mandated by law (in certain states) to engage in honest discussions using data concerning end of life care and expectations.