Abstract
Aims
The association between cancer and survival after out-of-hospital cardiac arrest (OHCA) has not been thoroughly investigated. We aimed to address this knowledge gap using national, population-based registries.
Methods and results
For this study, 30 163 patients with OHCA (≥18 years) were included from the Swedish Register of Cardiopulmonary Resuscitation. Through linkage to the National Patient Registry, 2894 patients (10%) with cancer diagnosed within 5 years prior to OHCA were identified. Differences in 30-day survival between patients with cancer and controls (defined as patients with OHCA without previous cancer diagnosis) were assessed related to cancer stage (locoregional vs. metastasized cancer) and cancer site (e.g. lung cancer, breast cancer, etc.) using logistic regression adjusted for prognostic factors. Long-term survival was presented as a Kaplan–Meier curve. For locoregional cancer, no statistically significant difference in return of spontaneous circulation (ROSC) was seen compared with controls, and metastasized disease was associated with a poorer chance of ROSC. Cancer was associated with a lower 30-day survival for all cancers [adjusted odds ratio (OR) 0.57, confidence interval (CI) 0.49–0.66], locoregional cancer (adjusted OR 0.68, CI 0.57–0.82), and metastasized cancer (adjusted OR 0.24, CI 0.14–0.40) compared with controls. A lower 30-day survival compared with controls was seen for lung, gynaecological and haematological cancers.
Conclusion
Cancer is associated with poorer 30-day survival after OHCA. This study suggests that cancer site and disease stage are more relevant factors than cancer in general with regard to its effect on survival after OHCA.
Keywords: Cardiac arrest, Cardio-oncology, Malignancy, Comorbidity, Survival
Graphical Abstract
Graphical Abstract.
Introduction
A significant improvement in cancer survival has been seen in the past two decades with a growing population of long-term cancer survivors.1 As a result of a growing number of cancer survivors and due to the increased risk of cardiovascular disease (CVD) and cardiovascular death among patients with cancer, the field of cardio-oncology has emerged.1 Out-of-hospital cardiac arrest (OHCA) is the deadliest form of CVD and a major public health concern with ∼300 000 cases reported yearly in Europe and a 30-day survival rate of ∼10%.2
The increased risk of CVD manifesting after a cancer diagnosis may be explained by shared risk factors, increased inflammation associated with cancer, as well as cardiotoxic effects of cancer therapy.1,3 The risk of CVD and cardiovascular death among patients with cancer has been seen to vary depending on the cancer site and stage.4,5 Previous studies of cardiac arrest among patients with cancer have primarily focused on in-hospital cardiac arrests, indicating that cancer is a negative prognostic factor in these cardiac arrests.6 Studies on survival after OHCA among patients with cancer are small scaled and inconsistent.7–11 As cardio-oncology evolves, identifying patients with cancer with an increased risk of death in cardiac arrest will be crucial, to enable the development of prevention strategies.
To optimize post-arrest treatment, it is important to understand which subgroups of the cancer population are at increased risk of death in case of an OHCA. To date, there are no larger, population-based studies on the association between cancer and survival after OHCA. We aimed to address this evidence gap through a nationwide, population-based register study.
Methods
Study design and setting
This nationwide observational study was based on Swedish, population-based registries, with a population of 10 million people and ∼6000 OHCA cases per year.12 In 2020, ∼62 500 patients were diagnosed with cancer in Sweden, and the 10-year survival is ∼70% in adults.13 In Sweden, the number of prevalent cases (5 years) was ∼218 000 in 2020.14
Data sources
This study was based on four national registries, linked to each other via personal identity numbers. All OHCA cases were taken from the Swedish Register of Cardiopulmonary Resuscitation (SRCR), our primary source of data, and linked to the National Patient Register (NPR) for cancer diagnosis. The SRCR is a national quality registry with a coverage of almost 100% of emergency medical services (EMSs).12 The SRCR includes all cardiac arrests out-of-hospital where cardiopulmonary resuscitation (CPR) is initiated either by a bystander or by EMS. The cardiac arrest is regarded as out-of-hospital when it occurs at home, in public as well as in other non-hospital sites; such as in nursing homes, healthcare clinics, and ambulances.12 The NPR is a national register of all in-patient care and specialized out-patient care, containing >95% of all main diagnoses.15 The NPR is coded according to the Swedish International Classification of Disease (ICD) system. More than 99% of all somatic hospital discharges (including surgery) are registered in the NPR. The National Board of Health and Welfare showed that 85–95% of all diagnosis from hospital discharge registered in the NPR are valid.16 Cancer sites were identified according to the 10th revision of the International Classification of Disease (ICD-10).17 The NPR also provided information on comorbidities for adjustment of the Charlson Comorbidity Index (excluding cancer).18 For long-term survival, OHCA cases were linked to the Cause of Death Register. Adjustments for socioeconomic status, related to educational level and disposable household income, were made based on data from Statistics Sweden’s LISA database.19
Study population and data collection
From 1 January 2010 to 31 December 2017, patients with OHCA (≥18 years of age) with initiated CPR and registered in the SRCR were included in the study. Cases without a personal identity number,20 with unknown 30-day survival, witnessed by EMS or in case of more than one OHCA during the follow-up time were excluded from the study (Figure 1). Patients with cancer diagnosed >5 years prior to the arrest were excluded from the study. Controls were defined as patients with OHCA registered in the SRCR 2010–2017 without a previous cancer diagnosis. The study, including the linkage of registries, is approved by the Swedish Ethical Review Authority. Out-of-hospital cardiac arrest survivors included in the SRCR are informed in writing about their inclusion in the register.
Figure 1.
Flow chart of patient selection. Out-of-hospital cardiac arrest cases included from the Swedish Register of Cardiopulmonary Resuscitation 2010–2017, linked to the National Patient Register for inclusion of cancer diagnosis.
Exposure
Cancer was defined as cancer diagnosed within 5 years prior to the arrest. Survival was assessed for cancer for all cancers (combined), related to cancer stage (locoregional and metastasized disease) and cancer site. ICD-codes C00-C96 were used to indicate cancer, and no benign neoplasms (D10-D36) were included (see Supplementary material online, Table S1).
Outcome
The primary outcome was defined as 30-day survival after OHCA [regardless of return of spontaneous circulation (ROSC)] for patients with cancer in general (all cancers) and subgroups. Subgroup analyses were performed in relation to cancer stage (locoregional vs. metastasized disease) and cancer site (e.g. lung cancer, breast cancer, prostate cancer, etc.) compared with OHCA cases without a cancer diagnosis (controls). Secondary outcomes were the ROSC, 30-day survival among patients with ROSC and long-term survival after OHCA related to the cancer stage. Long-term survival was defined as survival until the censoring date (31 December 2018) among 30-day survivors. An assessment of long-term survival was made based on data from the Swedish Cause of Death Register.
Statistical analyses
Baseline characteristics were presented as numbers and proportions for categorical variables and medians with an interquartile range (the 25th–75th percentile) for continuous variables. Balance was assessed using standardized mean differences. Missing data were handled with multiple imputation by chained equations under the assumption that missing data were missing at random. Ten data sets were created, and the results were pooled using Rubin’s Rules. Logistic regression was used for the assessment of ROSC and for all analyses of 30-day survival as an outcome. For ROSC and 30-day survival related to the cancer stage, adjustments were made stepwise in five models, set a priori. The first model shows unadjusted survival for cancer compared with controls. For Model 2 (primary model), results were adjusted for sex (man/woman), age (as a restricted cubic spline with three knots), by using the default settings format natural spline in R [from the function splines::ns(var, 3)], Charlson Comorbidity Index (excluding cancer), socioeconomic status, and region of Sweden where the OHCA occurred. Socioeconomic status included disposable family household income and education level. Household income was categorized into quintiles, while education was categorized into the following five categories: primary (0–9 years of education), secondary (10–12 years of education), post-secondary <3 years (13–14 years of education), post-secondary 3 years (15 years of education), and post-secondary 4 years or more (>15 years of education). The educational levels used in the study do not correspond to the ISCED levels. Model 3 was additionally adjusted for the location of the OHCA (home, public, or other) and witness status. Model 4 was adjusted for ditto adding bystander CPR and EMS arrival time (i.e. time from emergency call to EMS arrival) and Model 5 was additionally adjusted for the initial rhythm of the cardiac arrest. The results of the adjusted analysis were presented as odds ratios (ORs) with 95% confidence intervals (CIs). A P-value of <0.05 was regarded as statistically significant. Adjustments for socioeconomic status, related to educational level and disposable household income, were made based on data from Statistics Sweden’s (SCB) LISA database.19 For 30-day survival related to cancer site, results were adjusted for sex, age, Charlson Comorbidity Index (excluding cancer), and socioeconomic status (in the same manner as for cancer stage). For the assessment of survival after OHCA among patients with gynaecological and breast cancer, controls were solely constituted by women, likewise, for patients with prostate cancer, survival was assessed by comparing male OHCA cases exclusively. Among 30-day survivors, long-term survival for locoregional and metastasized cancer was presented using Kaplan–Meier survival curves. R version 4.2.2 was used for all analyses in the study.
Results
Study population
In this study, 30 163 OHCA cases were included, of which 2894 patients (10%) had cancer diagnosed within 5 years prior to the arrest, and 27 269 without previous cancer diagnosis (control group). The most common cancer diagnoses prior to the OHCA among male patients were prostate cancer (32%), genitourinary cancers (14%), and lung cancer (14%) (see Supplementary material online, Figure S1). Among female patients, the most common pre-OHCA cancer diagnoses were cancer of the breast (21%), lung (20%), and colorectum (12%) (see Supplementary material online, Figure S1).
Patient characteristics
Compared with patients with no cancer diagnosis, patients with locoregional cancer prior to the arrest were older (76 vs. 71 years, Table 1) while patients with metastasized cancer were slightly younger (70 vs. 71 years). Regarding income level, patients with metastatic cancer had higher income compared with both locoregional and patients with no cancer diagnoses. It was more common for the OHCA to occur at home for patients with locoregional cancer and metastasized cancer compared with patients with no cancer (81 and 89%, respectively, vs. 72%). Cardiac origin as the cause of the cardiac arrest was similar for locoregional cancer and the controls; however, less common for metastasized cancer. Initiation of bystander CPR was slightly less common for the group with cancer compared with those without (locoregional cancer 56%, metastasized cancer 57 vs. 60%). No significant difference in EMS response time was seen for the three groups. Patients with cancer had a lower proportion of shockable first rhythm compared with patients without cancer, most prominent for metastasized cancer (20% for locoregional cancer and 11% for metastasized disease, vs. 23% for controls).
Table 1.
Background characteristics of out-of-hospital cardiac arrest patients registered in the Swedish Register of Cardiopulmonary Resuscitation 2010–2017
| No cancer | Locoregional | Metastasized | SMD | Missing data | |
|---|---|---|---|---|---|
| Number of patients | 27 269 | 2303 | 591 | ||
| Age | 71.0 (59.0–81.0) | 76.0 (69.0–84.0) | 70.0 (63.0–78.0) | 0.386 | 0.0 |
| Sex (female) | 8937 (32.8) | 677 (29.4) | 236 (39.9) | 0.148 | 0.0 |
| Income quintile | 0.165 | 0.6 | |||
| 1 | 5502 (20.3) | 408 (17.7) | 89 (15.1) | ||
| 2 | 5372 (19.8) | 517 (22.5) | 110 (18.7) | ||
| 3 | 5421 (20.0) | 469 (20.4) | 109 (18.5) | ||
| 4 | 5322 (19.6) | 523 (22.7) | 153 (26.0) | ||
| 5 | 5486 (20.2) | 385 (16.7) | 127 (21.6) | ||
| Educational level quintile | 0.066 | 2.8 | |||
| Primary | 11 217 (42.3) | 974 (43.3) | 236 (41.0) | ||
| Secondary | 10 916 (41.2) | 882 (39.2) | 234 (40.6) | ||
| Post secondary (<3 years) | 2031 (7.7) | 182 (8.1) | 49 (8.5) | ||
| Post secondary (3 years) | 1214 (4.6) | 90 (4.0) | 30 (5.2) | ||
| Post secondary (≥4 years) | 1130 (4.3) | 121 (5.4) | 27 (4.7) | ||
| Location of OHCA | 0.305 | 0.0 | |||
| Home | 19 605 (71.9) | 1865 (81.0) | 525 (88.8) | ||
| Public | 5225 (19.2) | 283 (12.3) | 34 (5.8) | ||
| Other | 2429 (8.9) | 154 (6.7) | 32 (5.4) | ||
| Cardiac origin | 21 981 (84.0) | 1879 (84.8) | 430 (76.1) | 0.147 | 4.0 |
| Bystander CPR | 16 337 (59.9) | 1284 (55.8) | 337 (57.0) | 0.056 | 0.0 |
| Arrival time | 9.3 (6.0–15.0) | 9.0 (6.0–14.0) | 10.0 (7.0–15.0) | 0.044 | 4.8 |
| VT/VF (shockable rhythm) | 6138 (23.1) | 451 (20.1) | 62 (10.8) | 0.220 | 2.4 |
| ROSC | 9510 (35.1) | 765 (33.4) | 147 (25.0) | 0.147 | |
| 30-Day survival | 2733 (10.0) | 132 (5.7) | 15 (2.5) | 0.211 | |
| Any cancer | 0 (0.0) | 2303 (100.0) | 591 (100.0) | NaN | 0.0 |
| Breast | 0 (0.0) | 165 (7.2) | 37 (6.3) | 0.265 | 0.0 |
| Prostate | 0 (0.0) | 564 (24.5) | 76 (12.9) | 0.550 | 0.0 |
| Malignant melanoma | 0 (0.0) | 121 (5.3) | 26 (4.4) | 0.225 | 0.0 |
| Colorectal | 0 (0.0) | 257 (11.2) | 82 (13.9) | 0.384 | 0.0 |
| Lung | 0 (0.0) | 277 (12.0) | 180 (30.5) | 0.640 | 0.0 |
| Gastrointestinal tract | 0 (0.0) | 164 (7.1) | 101 (17.1) | 0.448 | 0.0 |
| Genitourinary | 0 (0.0) | 269 (11.7) | 50 (8.5) | 0.350 | 0.0 |
| Gynaecological | 0 (0.0) | 64 (2.8) | 39 (6.6) | 0.265 | 0.0 |
| Head and neck | 0 (0.0) | 139 (6.0) | 24 (4.1) | 0.247 | 0.0 |
| Haematological | 0 (0.0) | 237 (10.3) | 14 (2.4) | 0.343 | 0.0 |
| Skin (non-malignant melanoma)a | 0 (0.0) | 179 (7.8) | 4 (0.7) | 0.295 | 0.0 |
| Other | 0 (0.0) | 108 (4.7) | 47 (8.0) | 0.288 | 0.0 |
Results presented as a number and/or proportions for categorical variables and medians with interquartile range for continuous variables.
OHCA, out-of-hospital cardiac arrest; SMD, standardized mean difference; VF, ventricular fibrillation; VT, ventricular tachycardia.
Excluding basal-cell carcinoma.
Return of spontaneous circulation
Among OHCA patients with cancer, 33% with locoregional cancer and 25% with metastasized cancer had a ROSC, compared with 35% for patients with no cancer diagnosis. No statistically significant difference in ROSC was seen for patients with OHCA with locoregional cancer compared with controls. Metastasized disease was associated with poorer chance of ROSC compared with controls (OR 0.60, CI 0.50–0.73) adjusted by age, sex, socioeconomic status, Charlson Comorbidity Index (excluding cancer), and region of Sweden where the OHCA occurred (Figure 2).
Figure 2.
Return of spontaneous circulation after out-of-hospital cardiac arrest 2010–2017 related to cancer stage.
30-Day survival
Patients with no previous cancer diagnosis had a 30-day survival rate of 9.4% (2564/27 269), patients with locoregional cancer had a survival rate of 5.7% (132/2303) and patients with metastasized cancer had a 30-day survival rate of 2.5% (15/591). Compared with patients with no cancer diagnosis, both locoregional cancer (OR 0.68, CI 0.57–0.82) and metastasized cancer (OR 0.24, CI 0.14–0.40) had a lower chance of 30-day survival after adjustment for potential confounders (Figure 3, Model 2). The 30-day survival remained significantly lower for both locoregional and metastasized disease when additionally adjusting for the location of the OHCA (home, public, or other), witness status, bystander CPR, and EMS arrival time as well as for initial rhythm. For patients with ROSC, cancer was associated with poorer 30-day survival compared with controls; for both locoregional cancer (OR 0.67, CI 0.55–0.83) and metastasized (OR 0.30, CI 0.17–0.52) (see Supplementary material online, Table S2, Model 2). Complete case analysis of 30-day survival in supplementary material (see Supplementary material online, Table 4)
Figure 3.
30-Day survival after out-of-hospital cardiac arrest 2010–2017 related to cancer stage.
30-Day survival by cancer site
Survival after OHCA varied by cancer site (Figure 4), a significantly lower survival compared with controls was seen for lung cancer (OR 0.07, CI 0.02–0.21), gynaecological cancer (OR 0.14, CI 0.02–0.98), and haematological cancers (OR 0.54, CI 0.30–0.97) when adjusted by sex, age, socioeconomic status, and comorbidities.
Figure 4.
30-Day survival after out-of-hospital cardiac arrest 2010–2017 related to cancer site.
Long-term survival (among 30-day survivors)
Long-term survival, among patients alive 30 days after the arrest, was lower for locoregional cancer as well as metastasized cancer, compared with patients with no cancer diagnosis (Figure 5). Median survival time for patients with OHCA was 1660 days for locoregional cancer and 156 days for metastasized cancer. Patients without cancer diagnosis did not reach median survival (69% were alive at censoring date). Survival at 1 year after OHCA was 83% and 40% for locoregional and metastasized, respectively, compared with 91% for patients without cancer. At 5 years, survival for locoregional and metastasized cancer was 50% and 8% compared with 77% for OHCA without cancer. Maximum follow-up time was 3285 days.
Figure 5.
Long-term survival after out-of-hospital cardiac arrest 2010–2017 related to cancer stage.
Discussion
This is the first nationwide study of OHCA among patients with cancer. Our main finding was poorer short-term survival (30-day survival) for patients with cancer after OHCA. In this comprehensive assessment of survival after OHCA, we found lower 30-day survival for all cancers, locoregional and metastasized cancer, and three cancer sites. For locoregional cancer, no statistically significant difference in ROSC was seen compared with controls, though a lower 30-day survival. For patients with OHCA with metastasized disease, a significantly lower proportion was seen for both ROSC and 30-day survival. Among 30-day survivors, long-term survival after OHCA was lower for locoregional and metastasized cancer, compared with controls.
The study investigates survival after OHCA among patients with active cancer, defined as cancer diagnosed within 5 years of the OHCA. The cancer population was narrowed down in such manner partly to minimize inclusion of patients cured from their cancer disease. Moreover, patients still alive 5 years after diagnosis are usually considered statistically cured, because the death rates of this group are similar to those of the general population, with some exceptions.21
The order of magnitude of the cancer sites in the OHCA population corresponds in general to that of the population of Sweden. However, all sites are overrepresented in the OHCA population compared with the prevalence in Sweden (see Supplementary material online, Table S3).
Patients with OHCA with cancer prior to the arrest had unfavourable prognostic factors such as more arrests at home and fewer cases with bystander CPR. In this study, we found that the association between cancer and survival after OHCA was lower for both locoregional and metastasized cancer when adjusting for prognostic factors. Winther-Jensen et al.8 found, in contradiction to our results, no significant difference in survival after OHCA for patients with cancer when adjusting for prognostic factors. This difference in findings might be due to factors such as their small sample size. Further, Winther-Jensen et al. excluded patients with unsuccessful resuscitation attempts (i.e. might not include patients with poorest prognosis); however, in this study, poorer 30-day survival was seen among patients with ROSC, although with slightly weaker association than our main analysis including patients regardless of ROSC.
Another negative prognostic factor for survival after OHCA is old age. In our study, patients with metastasized cancer were younger compared with both locoregional cancer and controls. Previous studies have shown that metastasized cancer is associated with an increased risk of death in CVD, partly due to the intense treatment given to these patients.3 Accordingly, the younger age among patients with metastasized cancer in this study might be explained by the cancer treatment and the following cardiovascular risk; it may also be attributed to a potential restraint from using CPR for older patients with metastasized cancer - however, this is speculation and relevant data are lacking in this study. A previous study of cardiac arrest among patients with cancer found that resuscitated patients with palliative care are younger than patients with cancer without palliative care, which could be another factor to explain the age difference.22 It should be stressed that only OHCA cases with initiated CPR are included in this study.
Previous cancer was associated with a lower proportion of arrests with shockable initial rhythm, particularly for metastasized cancer. When adjusting for initial rhythm, survival remains lower for patients with cancer compared with patients without cancer diagnosis; this was however only included as an additional analysis due to the uncertainty as to whether the initial rhythm is a factor of the origin of the arrest or a factor of time. Cardiac arrests with a shockable first rhythm occur mainly in arrests of cardiac origin and are inversely correlated to the arrival time (i.e. time from emergency call to EMS arrival).23 Our results show fewer arrests with cardiac origin in the group of metastasized cancer as well as no significant difference in arrival time, indicating that the initial rhythm is more likely due to the origin of the arrest, and is thus a true negative prognostic factor that should not be adjusted for.
Among the patients with OHCA in this study, no statistically significant difference in ROSC was seen for locoregional cancer compared with controls, metastasized disease was associated with poorer chance of ROSC. However, data on CPR duration are missing in the SRCR, and there is therefore some uncertainty as to whether the treatment was terminated earlier for the group with metastasized cancer. Our results indicate that patients with pre-OHCA cancer have poorer prognosis following ROSC, particularly the group of locoregional cancer with no difference in ROSC and a lower 30-day survival compared with controls. This could be due to the cancer disease itself; however, it could also be due to the treatment given and measures taken at the hospital after ROSC for patients with cancer diagnosis. In clinical practice, a cancer diagnosis might influence if advanced intensive care unit (ICU) treatment is given or other invasive measures are taken in case of an OHCA.
This study is the first study to examine survival after OHCA related to both cancer stage and cancer site to our knowledge. Lower 30-day survival was seen regardless of cancer stage, although metastasized cancer was associated with a markedly poorer survival rate. This result concurs with Hirlekar et al.2 showing that increasing comorbidity is associated with decreased survival after OHCA. We found a significantly lower 30-day survival for three cancer sites. We do not know why these specific cancer types are associated with decreased survival. However, one could imagine that a correlation between the severity of the cancer disease and the survival of OHCA is likely. Additionally, the overall health of the patients, including cancer treatment and comorbidities, is likely to affect the survival both directly and indirectly by having an impact on the withdrawal of life support as well as post-arrest treatment given. The results of the current study only provide associations, and it cannot be excluded that there might be confounding factors not accounted for affecting the results.
The finding of lower long-term survival after OHCA in this study is in line with several previous studies.10,11 However, when adjusting for prognostic factors, one study8 found no significant difference in long-term survival after OHCA among patients with cancer compared with controls. Our study shows that metastasized disease is associated with markedly poorer long-term survival after OHCA, also in comparison with locoregional disease. The cancer disease itself could probably explain the lower long-term survival after OHCA among patients with metastasized disease to a great degree.
The current study is of clinical importance for the growing number of patients with cancer and could have a part in developing guidelines for future advanced care planning. Understanding which subgroups of the cancer population who are at an increased risk in case of an OHCA is important in order to optimize post-arrest treatment. This study indicates that cancer diagnosis, in general, might not singularly be a sufficient reason to terminate arrest treatment, but instead that individual assessment of cancer site and cancer stage is needed to provide the best possible treatment and to minimize harm in case of an OHCA. However, studies including data on withdrawal of care and post-arrest treatment are needed to be able to draw conclusions on whether the cancer itself causes poorer survival or if it is caused by early withdrawal of life support and undertreatment.
Strengths and limitations
The present study has limitations. The study solely includes OHCA with initiated CPR, and the duration of CPR and the reasons for termination are not known. The in-hospital treatment given post-OHCA was not included due to poor validation of these variables in the SRCR, and this is why conclusions on the reason for the disparity in survival cannot be drawn. Due to a lot of missing data on neurological outcome, this variable was not included. Further, cause of death was not included in the study due to a lack of reliable data. Moreover, the study did not take antineoplastic treatment into consideration due to a lack of comprehensive data. Multiple oncological treatments have cardiac side effects and could so forth theoretically have an impact on survival after OHCA. However, the study is the first nationwide and most extensive study of OHCA among patients with cancer. The SRCR covers almost 100% of EMS participate in Sweden. The NPR is calculated to contain >95% of all main diagnoses. These all-encompassing national registries allow for subgroup analyses of the survival rate after OHCA among the cancer population as well as comprehensive adjustments of prognostic factors.
Conclusions
In this study, we found that cancer diagnosis is associated with poorer 30-day survival after OHCA. This study suggests that cancer site and disease stage are more relevant factors than cancer in general with regard to its effect on survival after OHCA. For locoregional cancer, no significant difference is seen in ROSC compared with controls; however, poorer 30-day survival is seen for this group. Further studies are warranted to examine the cause of these disparities, to understand if it is the cancer itself or undertreatment driving this poor outcome among patients with locoregional cancer.
Supplementary Material
Contributor Information
Hanna L Hägglund, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, D1: 04. 171 76 Stockholm, Sweden.
Martin Jonsson, Department of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden.
Elham Hedayati, Department of Oncology-Pathology, Karolinska Institutet, Solna, Sweden; Breast Cancer Center, Cancer Theme, Karolinska University Hospital, Karolinska CCC, Stockholm, Sweden.
Christel Hedman, Department of Molecular Medicine and Surgery, Karolinska Institutet, Solna, Sweden; Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden; R&D Department, Stockholms Sjukhem Foundation, Stockholm, Sweden.
Therese Djärv, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, D1: 04. 171 76 Stockholm, Sweden.
Supplementary material
Supplementary material is available at European Heart Journal: Acute Cardiovascular Care.
Funding
None declared.
Data availability
The data that support the findings of this study cannot be shared due to privacy reasons.
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Data Availability Statement
The data that support the findings of this study cannot be shared due to privacy reasons.