Outcome of stage IV cancer patients receiving in-hospital cardiopulmonary resuscitation: a population-based cohort study

Abstract Purpose Studies to examine the impact of end-of-life (EOL) discussions on the utilization of life-sustaining treatments near death were limited and had inconsistent findings. This nationwide population-based cohort study determined the impact of EOL discussions on the utilization of life-sustaining treatments in the last three months of life in Taiwanese cancer patients. Methods This cohort study included adult cancer patients from 2012–2018, which were confirmed by pathohistological reports. Life-sustaining treatments during the last three months of life included cardiopulmonary resuscitation, intubation, and defibrillation. EOL discussions in cancer patients were confirmed by their medical records. Association of EOL discussions with utilization of life-sustaining treatments were assessed using multiple logistic regression. Results Of 381,207 patients, the mean age was 70.5 years and 19.4% of the subjects utilized life-sustaining treatments during the last three months of life. After adjusting for other covariates, those who underwent EOL discussions were less likely to receive life-sustaining treatments during the last three months of life compared to those who did not (Adjusted odds ratio [AOR]: 0.82; 95% confidence interval [CI]: 0.80–0.84). Considering the type of treatments, EOL discussions correlated with a lower likelihood of receiving cardiopulmonary resuscitation (AOR = 0.43, 95% CI: 0.41–0.45), endotracheal intubation (AOR = 0.87, 95%CI: 0.85–0.89), and defibrillation (AOR = 0.52, 95%CI: 0.48–0.57). Conclusion EOL discussions correlated with a lower utilization of life-sustaining treatments during the last three months of life among cancer patients. Our study supports the importance of providing these discussions to cancer patients to better align care with preferences during the EOL treatment.

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Faculty Opinions recommendation of Hospitalisation for venous thromboembolism in cancer patients and the general population: a population-based cohort study in Denmark, 1997-2006.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.5232956.5173054 ◽

2010 ◽

Author(s):

Chris Forsmark ◽

Dennis Collins

Keyword(s):

Cohort Study ◽

Venous Thromboembolism ◽

General Population ◽

Cancer Patients ◽

Population Based

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Aromatase inhibitors use and risk for cardiovascular disease in breast cancer patients: A population-based cohort study

The Breast ◽

10.1016/j.breast.2021.07.004 ◽

2021 ◽

Author(s):

Maria Sund ◽

Miguel Garcia-Argibay ◽

Hans Garmo ◽

Johan Ahlgren ◽

Anna-Karin Wennstig ◽

...

Keyword(s):

Breast Cancer ◽

Cardiovascular Disease ◽

Cohort Study ◽

Cancer Patients ◽

Aromatase Inhibitors ◽

Population Based ◽

Breast Cancer Patients

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A commentary on “Primary tumor removal improves the prognosis in patients with stage IV breast cancer: A population-based study (cohort study)” (Int J Surg 2020; 83: 109–114)

International Journal of Surgery ◽

10.1016/j.ijsu.2021.106029 ◽

2021 ◽

pp. 106029

Author(s):

Jing Gao ◽

Xiaoli Xu

Keyword(s):

Breast Cancer ◽

Cohort Study ◽

Primary Tumor ◽

Stage Iv ◽

Population Based ◽

Study Cohort ◽

Tumor Removal ◽

Population Based Study ◽

Stage Iv Breast Cancer

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Exploratory Study of Advance Care Discussions Among Chinese American and White Stage IV Cancer Patients at an American Tertiary Medical Center

American Journal of Hospice and Palliative Medicine® ◽

10.1177/10499091211012614 ◽

2021 ◽

pp. 104990912110126

Author(s):

Avery Caz Glover ◽

Courtney Schroeder ◽

Emma Ernst ◽

Tamara Vesel

Keyword(s):

Cancer Patients ◽

Exploratory Study ◽

Stage Iv ◽

Chinese American ◽

Chinese Americans ◽

Do Not Resuscitate ◽

Essential Components ◽

Advance Care ◽

Stage Iv Cancer ◽

White Patients

Purpose: Timely advance care discussions are essential components of quality care for diverse populations; however, little is known about these conversations among Chinese American cancer patients. This exploratory study describes differences in advance care discussions and planning between Chinese American and White advanced cancer patients. Methods: We collected data for 63 Chinese American and 63 White stage IV cancer patients who died between 2013 and 2018. We compared: frequency and timing of prognosis, goals of care (GOC), and end-of-life care (EOLC) discussions in the final year of life; family inclusion in discussions; healthcare proxy (HCP) identification; do not resuscitate (DNR) order, do not intubate (DNI) order, and other advance directive (AD) completion. We did not conduct statistical tests due to the study’s exploratory nature. Results: Among Chinese American and White patients, respectively, 76% and 71% had prognosis, 51% and 56% had GOC, and 89% and 84% had EOLC discussions. Prognosis, GOC, and EOLC discussions were held a median of 34.0, 15.5, and 34.0 days before death among Chinese American and 17.0, 13.0, and 24.0 days before death among White patients. Documentation rates among Chinese American and White patients were 79% and 76% for DNRs, 81% and 71% for DNIs, 79% and 81% for HCPs, and 52% and 40% for other ADs. Conclusions: Findings suggest that Chinese Americans had similar rates of advance care discussions, completed conversations earlier, and had similar to higher rates of AD documentation compared to White patients. Further studies are needed to confirm our preliminary findings.

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