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 stage of cancer may result in cardiopulmonary arrest (CPA) and resuscitation, which may not align with patient preferences. The characteristics and care experiences of patients transported in CPA have not been well studied in Japan. This study aimed to describe the characteristics and end-of-life (EOL) care experiences of patients with terminal cancer 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 and linked to death certificates. 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. Patients were categorized based on their CPA status at EMS transport. Results Among 4,939 patients, 178 (3.6%) had CPA. The CPA group had more lung cancer (+ 8.0%) and less colorectal (− 7.2%) and hepatobiliary/pancreatic cancers (− 8.2%). They were less likely to have reported do-not-resuscitate status (55.9% vs. 92.6%), had in resuscitation discussions (46.5% vs. 62.1%), or EOL discussions with family (39.5% vs. 50.8%). Out-of-pocket expenses were lower (41.2% under ¥100,000 vs. 21.7%). They reported lower symptom burden and slightly higher perceived death quality (+ 5.0 points). Conclusions Patients transported in CPA experienced fewer EOL discussions and preparedness, socioeconomic disparities, and distinct perceptions of death quality. These findings emphasize the need to enhance advance care planning communication and emergency preparedness in EOL cancer care.