1497P - Resuscitation decisions in advanced cancer: A mixed methods study exploring survival outcomes and views of healthcare professionals

Background

Resuscitation decisions in cancer patients continue to challenge Healthcare Professionals (HCPs) and often do not take place until clinical deterioration, risking futile Cardiopulmonary Resuscitation (CPR) attempts. This research investigated outcomes of In-Hospital Cardiopulmonary Arrest (IHCA) in advanced cancer within an NHS Trust in the UK, alongside viewpoints of HCPs.

Methods

This mixed-methods study comprised two components. Retrospective data analysis examined IHCA outcomes in patients with advanced cancer in Newcastle upon Tyne Hospitals NHS Foundation Trust (NUTH) between 2012-2022. Main outcomes included rate of Return of Spontaneous Circulation (ROSC) and survival to discharge. Other outcomes were median overall and post-discharge survival. A survey was distributed to senior HCPs in Acute Medicine (AM), Emergency Medicine (EM) and Oncology, to establish perceptions of CPR success in advanced cancer, and gather current opinion on issues surrounding resuscitation in this context.

Results

Among 83 patients, rate of ROSC was 33.7% and 9.6% survived to discharge. Among survivors, median overall survival was 2 days, and post-discharge survival 391 days. 92 HCPs responded to the survey. The mean likelihood of a patient with advanced cancer achieving ROSC was estimated at 13.4%. Oncologists were ranked the most appropriate HCP to discuss resuscitation, and outpatient clinic appointments the most suitable place. From analysis of text comments, important themes were (1) Place, person and timing, (2) Individualised decision-making, and (3) Improving patient understanding.

Conclusions

Survival following CPR is poor in advanced cancer, and fewer than 10% patients in this study gained any meaningful survival benefit. A collective approach is needed from HCPs to integrate personalised discussions about future care and resuscitation into routine cancer management. These should begin early rather than at a time of crisis, with someone the patient trusts. Blanket decisions are not suitable for any patient and cannot supersede clinical judgement alongside assessment of patient priorities and values.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Newcastle Hospitals Charity.

Disclosure

All authors have declared no conflicts of interest.