Impact of a Rapid Response Team in Oncological Settings and Associated Outcomes

Background and aim Despite advances in oncological therapies, hospitalized cancer patients remain at high risk of clinical deterioration, morbidity, and mortality. Rapid response teams (RRTs) aim to identify early deterioration and facilitate timely intervention; however, their association with outcomes in oncology populations remains uncertain. This study aimed to describe the characteristics and outcomes associated with RRT activation among hospitalized oncology patients. The primary outcome was hospital mortality; secondary outcomes included ICU transfer, facilitation of do-not-resuscitate (DNR) decisions, and ICU readmission. Methods This retrospective, observational, single-center cohort study without a comparison group was conducted over six months (July 1 to December 31, 2019) at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore. Adult oncology inpatients with a National Early Warning Score (NEWS) ≥7 triggering RRT activation were included. Patients with preexisting DNR or comfort-care-only status and non-oncology patients were excluded. Data on demographics, malignancy type, cause of deterioration, interventions, ICU transfer, DNR facilitation, readmissions, and mortality were extracted from the hospital information system and analyzed using IBM SPSS Statistics for Windows, version 27.0 (released 2019; IBM Corp., Armonk, NY, USA). Results A total of 302 patients met the inclusion criteria. The most common causes of deterioration were pulmonary (37.2%), infectious (21.3%), and neurological (12.2%) conditions. Following RRT activation, patients were transferred to the ICU in 35.8% of cases, remained on the ward following escalation of care in 30.1%, and had facilitation of a DNR decision in 32.5%. Cardiorespiratory arrest occurred in 1.6% of activations, and ICU readmission occurred in 13.0% of patients transferred to the ICU. The overall hospital mortality rate was 5.4% (54 per 1,000 admissions; 353/6,560), while mortality among patients requiring ICU transfer after RRT activation was substantially higher, at 54.6% (59/108). Conclusions RRT activation in this oncology population was associated with ICU transfer, ward-based escalation of care, and facilitation of goals-of-care discussions. Cancer patients who required ICU admission after RRT activation experienced high mortality. As this was a retrospective, single-center, observational study without a comparison group, these findings represent associations rather than evidence of RRT effectiveness; prospective, comparative studies are needed to determine which patients are most likely to benefit from ICU-level versus palliative care.