Relationship between Patient Characteristics and the Timing of Provision of Explanation about DNAR to Patients with Advanced Lung Cancer

Minehiko Inomata; Takahiro Hirai; Naoki Takata; Nozomu Murayama; Kana Hayashi; Zenta Seto; Kotaro Tokui; Seisuke Okazawa; Kenta Kambara; Shingo Imanishi; Toshiro Miwa; Shoko Matsui; Ryuji Hayashi; Kazuyuki Tobe

doi:10.2169/internalmedicine.4704-20

ORIGINAL ARTICLES

Relationship between Patient Characteristics and the Timing of Provision of Explanation about DNAR to Patients with Advanced Lung Cancer

Minehiko Inomata, Takahiro Hirai, Naoki Takata, Nozomu Murayama, Kana Hayashi, Zenta Seto, Kotaro Tokui, Seisuke Okazawa, Kenta Kambara, Shingo Imanishi, Toshiro Miwa, Shoko Matsui, Ryuji Hayashi, Kazuyuki Tobe

Author information

Minehiko Inomata
First Department of Internal Medicine, Toyama University Hospital, Japan
Takahiro Hirai
First Department of Internal Medicine, Toyama University Hospital, Japan
Naoki Takata
First Department of Internal Medicine, Toyama University Hospital, Japan
Nozomu Murayama
First Department of Internal Medicine, Toyama University Hospital, Japan
Kana Hayashi
First Department of Internal Medicine, Toyama University Hospital, Japan
Zenta Seto
First Department of Internal Medicine, Toyama University Hospital, Japan
Kotaro Tokui
First Department of Internal Medicine, Toyama University Hospital, Japan
Seisuke Okazawa
First Department of Internal Medicine, Toyama University Hospital, Japan
Kenta Kambara
First Department of Internal Medicine, Toyama University Hospital, Japan
Shingo Imanishi
First Department of Internal Medicine, Toyama University Hospital, Japan
Toshiro Miwa
First Department of Internal Medicine, Toyama University Hospital, Japan
Shoko Matsui
First Department of Internal Medicine, Toyama University Hospital, Japan
Ryuji Hayashi
Department of Medical Oncology, Toyama University Hospital, Japan
Kazuyuki Tobe
First Department of Internal Medicine, Toyama University Hospital, Japan

Keywords: advance care planning, Do Not Attempt Resuscitation, lung cancer, palliative care

JOURNAL OPEN ACCESS

2020 Volume 59 Issue 23 Pages 2989-2994

DOI https://doi.org/10.2169/internalmedicine.4704-20

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Abstract

Objective The aim of the present study was to analyze the relationship between the patient characteristics and the timing of provision of an explanation about "Do Not Attempt Resuscitation (DNAR)" by attending physicians to advanced lung cancer patients.

Methods We conducted a retrospective analysis of patients with advanced or postoperative recurrent lung cancer in whom systemic therapy was initiated between 2015 and 2016.

Results The data of a total of 74 patients with lung cancer, including 59 patients with non-small cell lung cancer and 15 with small cell lung cancer were analyzed. The median overall survival of the patients was 10.0 months. Records of the explanation about DNAR by the physicians were available for 57 of the 74 (77.0%) patients. For 48 (64.9%) patients, the explanation was provided after the discontinuation of anticancer treatment, and for 9 (12.2%) patients, it was provided during the course of anticancer treatment. The provision of an explanation about DNAR during the course of treatment was associated with a poor performance status at the start of treatment (p=0.028), the tumor histology (p=0.037), the presence of driver gene mutation in the tumor (p=0.029), and shorter survival after the discontinuation of anticancer treatment (p<0.001).

Conclusion The results suggested that the timing of provision of an explanation about DNAR was associated with patient characteristics and the predicted prognosis.

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