Top

Published in:

01-02-2017 | Review Article

Do-not-resuscitate orders in cancer patients: a review of literature

Authors: Aart Osinski, Gerard Vreugdenhil, Jan de Koning, Johannes G. van der Hoeven

Published in: Supportive Care in Cancer | Issue 2/2017

Abstract

Discussing do-not-resuscitate (DNR) orders is part of daily hospital practice in oncology departments. Several medical factors and patient characteristics are associated with issuing DNR orders in cancer patients. DNR orders are often placed late in the disease process. This may be a cause for disagreements between doctors and between doctors and patients and may cause for unnecessary treatments and admissions. In addition, DNR orders on itself may influence the rest of the medical treatment for patients. We present recommendations for discussing DNR orders and medical futility in practice through shared decision-making. Prospective studies are needed to investigate in which a patient’s cardiopulmonary resuscitation (CPR) is futile and whether or not DNR orders influence the medical care of patients.

Ebell MH, Doukas DJ, Smith MA (1991) The do-not-resuscitate order: a comparison of physician and patient preferences and decision-making. Am J Med 91(3):255–260CrossRefPubMed

Ebell MH (1994) Practical guidelines for do-not-resuscitate orders. Am Fam Physician 50(6):1293–1299 1303-1294PubMed

Hakim RB, Teno JM, Harrell FE Jr, Knaus WA, Wenger N, Phillips RS, Layde P, Califf R, Connors AF Jr, Lynn J (1996) Factors associated with do-not-resuscitate orders: patients’ preferences, prognoses, and physicians’ judgments. SUPPORT InvestigatorsStudy to understand prognoses and preferences for outcomes and risks of treatment. Ann Intern Med 125(4):284–293CrossRefPubMed

Reid C, Jeffrey D (2002) Do not attempt resuscitation decisions in a cancer centre: addressing difficult ethical and communication issues. Br J Cancer 86(7):1057–1060. doi:10.1038/sj.bjc.6600205 CrossRefPubMedPubMedCentral

Kim DY, Lee KE, Nam EM, Lee HR, Lee KW, Kim JH, Lee JS, Lee SN (2007) Do-not-resuscitate orders for terminal patients with cancer in teaching hospitals of Korea. J Palliat Med 10(5):1153–1158. doi:10.1089/jpm.2006.0264 CrossRefPubMed

Varon J, Marik PE (2007) Cardiopulmonary resuscitation in patients with cancer. Am J Hosp Palliat Care 24(3):224–229. doi:10.1177/1049909107301485 CrossRefPubMed

Hwang JP, Patlan J, de Achaval S, Escalante CP (2010) Survival in cancer patients after out-of-hospital cardiac arrest. Support Care Cancer: Off J Multinatl Assoc Support Care Cancer 18(1):51–55. doi:10.1007/s00520-009-0629-z CrossRef

Myrianthefs P, Batistaki C, Baltopoulos G (2010) Cardiopulmonary resuscitation in end-stage cancer patients. J BUON: Off J Balkan Union Oncol 15(1):25–28

Ebell MH, Afonso AM (2011) Pre-arrest predictors of failure to survive after in-hospital cardiopulmonary resuscitation: a meta-analysis. Fam Pract 28(5):505–515. doi:10.1093/fampra/cmr023 CrossRefPubMed

10.

Kjorstad OJ, Haugen DF (2013) Cardiopulmonary resuscitation in palliative care cancer patients. Tidsskrift for den Norske laegeforening: tidsskrift for praktisk medicin, ny raekke 133(4):417–421. doi:10.4045/tidsskr.12.0378 CrossRef

11.

Reisfield GM, Wallace SK, Munsell MF, Webb FJ, Alvarez ER, Wilson GR (2006) Survival in cancer patients undergoing in-hospital cardiopulmonary resuscitation: a meta-analysis. Resuscitation 71(2):152–160. doi:10.1016/j.resuscitation.2006.02.022 CrossRefPubMed

12.

Varon J, Walsh GL, Marik PE, Fromm RE (1998) Should a cancer patient be resuscitated following an in-hospital cardiac arrest? Resuscitation 36(3):165–168CrossRefPubMed

13.

Miller AH, Sandoval M, Wattana M, Page VD, Todd KH (2015) Cardiopulmonary resuscitation outcomes in a cancer center emergency department. Springer Plus 4:106. doi:10.1186/s40064-015-0884-z CrossRefPubMedPubMedCentral

14.

Ewer MS, Kish SK, Martin CG, Price KJ, Feeley TW (2001) Characteristics of cardiac arrest in cancer patients as a predictor of survival after cardiopulmonary resuscitation. Cancer 92(7):1905–1912CrossRefPubMed

15.

Vitelli CE, Cooper K, Rogatko A, Brennan MF (1991) Cardiopulmonary resuscitation and the patient with cancer. J Clin Oncol Off J Am Soc Clin Oncol 9(1):111–115

16.

Hinkka H, Kosunen E, Metsanoja R, Lammi UK, Kellokumpu-Lehtinen P (2001) To resuscitate or not: a dilemma in terminal cancer care. Resuscitation 49(3):289–297CrossRefPubMed

17.

de Decker L, Annweiler C, Launay C, Fantino B, Beauchet O (2014) Do not resuscitate orders and aging: impact of multimorbidity on the decision-making process. J Nutr Health Aging 18(3):330–335. doi:10.1007/s12603-014-0023-5 CrossRefPubMed

18.

Maida V, Peck J, Ennis M, Brar N, Maida AR (2010) Preferences for active and aggressive intervention among patients with advanced cancer. BMC Cancer 10:592. doi:10.1186/1471-2407-10-592 CrossRefPubMedPubMedCentral

19.

Chevaux F, Gagliano M, Waeber G, Marques-Vidal P, Schwab M (2015) Patients’ characteristics associated with the decision of “do not attempt cardiopulmonary resuscitation” order in a Swiss hospital. Eur J Intern Med 26(5):311–316. doi:10.1016/j.ejim.2015.04.003 CrossRefPubMed

20.

Parsons HA, de la Cruz MJ, Zhukovsky DS, Hui D, Delgado-Guay MO, Akitoye AE, El Osta B, Palmer L, Palla SL, Bruera E (2010) Characteristics of patients who refuse do-not-resuscitate orders upon admission to an acute palliative care unit in a comprehensive cancer center. Cancer 116(12):3061–3070. doi:10.1002/cncr.25045 CrossRefPubMed

21.

Hua M, Halpern SD, Gabler NB, Wunsch H (2016) Effect of ICU strain on timing of limitations in life-sustaining therapy and on death. Intensive Care Med 42(6):987–994. doi:10.1007/s00134-016-4240-8 CrossRefPubMed

22.

Keenan CH, Kish SK (2000) The influence of do-not-resuscitate orders on care provided for patients in the surgical intensive care unit of a cancer center. Crit Care Nurs Clin North Am 12(3):385–390PubMed

23.

Azad AA, Siow SF, Tafreshi A, Moran J, Franco M (2014) Discharge patterns, survival outcomes, and changes in clinical management of hospitalized adult patients with cancer with a do-not-resuscitate order. J Palliat Med 17(7):776–781. doi:10.1089/jpm.2013.0554 CrossRefPubMed

24.

Hermans HEGM, Buijsen MAJM (2010) Tweede, geheel herziene druk. Recht & gezondheidszorg. Maarssen: Elsevier Gezondheidszorg. Reed Business, Amsterdam

25.

Olver IN, Eliott JA, Blake-Mortimer J (2002) Cancer patients’ perceptions of do not resuscitate orders. Psycho-Oncology 11(3):181–187. doi:10.1002/pon.558 CrossRefPubMed

26.

Rose JH, O’Toole EE, Dawson NV, Lawrence R, Gurley D, Thomas C, Hamel MB, Cohen HJ (2004) Perspectives, preferences, care practices, and outcomes among older and middle-aged patients with late-stage cancer. J Clin Oncol: Off J Am Soc Clin Oncol 22(24):4907–4917. doi:10.1200/JCO.2004.06.050 CrossRef

27.

Covinsky KE, Fuller JD, Yaffe K, Johnston CB, Hamel MB, Lynn J, Teno JM, Phillips RS (2000) Communication and decision-making in seriously ill patients: findings of the SUPPORT project. The study to understand prognoses and preferences for outcomes and risks of treatments. J Am Geriatr Soc 48(5 Suppl):S187–S193CrossRefPubMed

28.

Wen KY, Lin YC, Cheng JF, Chou PC, Wei CH, Chen YF, Sun JL (2013) Insights into Chinese perspectives on do-not-resuscitate (DNR) orders from an examination of DNR order form completeness for cancer patients. Support Care Cancer: Off J Multinatl Assoc Support Care Cancer 21(9):2593–2598. doi:10.1007/s00520-013-1827-2 CrossRef

29.

Pettersson M, Hedstrom M, Hoglund AT (2014) Striving for good nursing care: nurses’ experiences of do not resuscitate orders within oncology and hematology care. Nurs Ethics 21(8):902–915. doi:10.1177/0969733014533238 CrossRefPubMed

30.

Stein RA, Sharpe L, Bell ML, Boyle FM, Dunn SM, Clarke SJ (2013) Randomized controlled trial of a structured intervention to facilitate end-of-life decision making in patients with advanced cancer. J Clin Oncol Off J Am Soc Clin Oncol 31(27):3403–3410. doi:10.1200/JCO.2011.40.8872 CrossRef

31.

Oh DY, Kim JH, Kim DW, Im SA, Kim TY, Heo DS, Bang YJ, Kim NK (2006) CPR or DNR? End-of-life decision in Korean cancer patients: a single center’s experience. Support Care Cancer: Off J Multinatl Assoc Support Care Cancer 14(2):103–108. doi:10.1007/s00520-005-0885-5 CrossRef

32.

Mori M, Ellison D, Ashikaga T, McVeigh U, Ramsay A, Ades S (2013) In-advance end-of-life discussions and the quality of inpatient end-of-life care: a pilot study in bereaved primary caregivers of advanced cancer patients. Support Care Cancer: Off J Multinatl Assoc Support Care Cancer 21(2):629–636. doi:10.1007/s00520-012-1581-x CrossRef

33.

Wright AA, Zhang B, Ray A, Mack JW, Trice E, Balboni T, Mitchell SL, Jackson VA, Block SD, Maciejewski PK, Prigerson HG (2008) Associations between end-of-life discussions, patient mental health, medical care near death, and caregiver bereavement adjustment. JAMA 300(14):1665–1673. doi:10.1001/jama.300.14.1665 CrossRefPubMedPubMedCentral

34.

Caissie A, Kevork N, Hannon B, Le LW, Zimmermann C (2014) Timing of code status documentation and end-of-life outcomes in patients admitted to an oncology ward. Support Care Cancer: Off J Multinatl Assoc Support Care Cancer 22(2):375–381. doi:10.1007/s00520-013-1983-4 CrossRef

35.

von Gunten CF (2001) Discussing do-not-resuscitate status. J Clin Oncol Off J Am Soc Clin Oncol 19(5):1576–1581

36.

Saltbaek L, Michelsen HM, Nelausen KM, Gut R, Nielsen DL (2013) Old age and poor prognosis increase the likelihood of disagreement between cancer patients and their oncologists on the indication for resuscitation attempt. Support Care Cancer: Off J Multinatl Assoc Support Care Cancer 21(12):3363–3370. doi:10.1007/s00520-013-1916-2 CrossRef

37.

Levin TT, Coyle N (2015) A communication training perspective on AND versus DNR directives. Palliat Support Care 13(2):385–387. doi:10.1017/S147895151400039X CrossRefPubMed

Title: Do-not-resuscitate orders in cancer patients: a review of literature
Authors: Aart Osinski
Gerard Vreugdenhil
Jan de Koning
Johannes G. van der Hoeven
Publication date: 01-02-2017
Publisher: Springer Berlin Heidelberg
Published in: Supportive Care in Cancer / Issue 2/2017
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI: https://doi.org/10.1007/s00520-016-3459-9

Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras

Prof. Fabrice Barlesi

Developed by: Springer Medicine

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 2/2017

Determining best methods to screen for religious/spiritual distress

Axillary web syndrome is not a risk factor for lymphoedema after 10 years of follow-up

The impact of a simplified documentation method for the Edmonton classification system for cancer pain (ECS-CP) on clinician utilization

Advance directives in patients with advanced cancer receiving active treatment: attitudes, prevalence, and barriers

Definition and estimation of osteonecrosis of jaw (ONJ), and optimal duration of antiresorptive treatment in bone metastatic cancer patients: supplementary data from the denosumab extension study?

The use of opioids in cancer patients with renal impairment—a systematic review

Keynote webinar | Spotlight on antibody–drug conjugates in cancer