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Comment & Response |

Cardiopulmonary Resuscitation and Benefit to Patients With Metastatic Cancer—Reply

Margaret L. Schwarze, MD, MPP1,2; Michael J. Nabozny, MD1; Nicole M. Steffens, MPH1,3
[+] Author Affiliations
1Department of Surgery, University of Wisconsin, Madison
2Department of Medical History and Bioethics, University of Wisconsin, Madison
3Denver Public Health, Denver Health and Hospital Authority, Denver, Colorado
JAMA Intern Med. 2016;176(1):142-143. doi:10.1001/jamainternmed.2015.7418.
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In Reply While we agree with Champingeulle et al that resuscitation techniques have improved over time, we have not found evidence that cardiopulmonary resuscitation (CPR) and other resuscitative efforts have been able to stop or delay death in those who are dying from end-stage cancer. Not all patients with metastatic cancer are the same, and the data from Reisfield et al1 describe a small group of patients with metastatic cancer who have a slight chance of benefiting from CPR to survive hospitalization. However, these data comprise a heterogeneous group of patients with a variety of cancer types and extent of disease so it is difficult to extrapolate these prognostic estimates to patients with late-stage cancer. Furthermore, as the authors of these articles note,13 the retrospective cohort that received CPR is highly selected and vastly overestimates the probability of surviving CPR for all patients with metastatic disease.

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January 1, 2016
Benoit Champigneulle, MD; Alain Cariou, MD, PhD; François Vincent, MD; for the Groupe de recherche en réanimation respiratoire en Onco-Hématologie (GrrrOH)
1Medical Intensive Care Unit, Cochin University Hospital, AP-HP, Paris, France
2Polyvalent Intensive Care Unit, GHIC Le Raincy-Montfermeil, Montfermeil, France
JAMA Intern Med. 2016;176(1):142. doi:10.1001/jamainternmed.2015.7415.
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