End-of-life emergency medical service transport among patients with terminal cancer by cardiopulmonary arrest status: A nationwide mortality follow-back survey.

PURPOSE: Emergency medical service (EMS) transport during the terminal stages of cancer may result in cardiopulmonary arrest (CPA) and resuscitation, which may not align with patient preferences. The characteristics and care experiences of CPA patients have not been well studied in Japan. We described the characteristics and end-of-life (EOL) care experiences of terminal cancer patients with and without CPA at EMS transport.

METHODS

We conducted a secondary analysis of a nationwide mortality follow-back survey (2019-2020) using structured questionnaires completed by bereaved family members linked to death certificate data. We analyzed 4,939 patients with terminal cancer who were transported by EMS in the final month of life and died in hospitals between 2017 and 2018. The patients were categorized according to their CPA status at EMS transport.

RESULTS

Among the 4,939 patients, 178 (3.6%) experienced CPA during EMS transport. The CPA group had a higher proportion of lung cancers and lower proportion of colorectal and hepatobiliary/pancreatic cancers. They were less likely to have a do-not-resuscitate (DNR) order (55.9% vs. 92.6%) or to have engaged in resuscitation (46.5% vs. 62.1%) or EOL discussions (39.5% vs. 50.8%). In addition, the CPA group reported lower out-of-pocket medical expenses (41.2% under ¥100,000 versus 21.7%), lower symptom burden, and a slightly higher perceived quality of death.

CONCLUSIONS

Patients transported in CPA experienced fewer EOL discussions, showed socioeconomic disparities, and had distinct perceptions of the quality of death. These findings emphasize the need to enhance advanced care planning communication and emergency preparedness in EOL cancer care.