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Influence of Malignancy on the Decision to Withhold or Withdraw Life-Sustaining Therapy in Critically Ill Patients

Division of Pulmonary and Critical Care Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, rcavallazzi{at}gmail.com

Amyn Hirani, MD

Division of Pulmonary and Critical Care Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania

Tajender S. Vasu, MD

Division of Pulmonary and Critical Care Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania

Monvasi Pachinburavan, MD

Division of Pulmonary and Critical Care Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania

Gregory C. Kane, MD

Division of Pulmonary and Critical Care Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania

Purpose: To evaluate the influence of malignancy on the decision to limit life-sustaining therapy in the intensive care unit (ICU). Methods: At the day of patients’ admission to the ICU, we prospectively collected information on demographics, acute physiology and chronic health evaluation (APACHE) II score, and features related to malignancy. We retrospectively collected information on in-hospital survival and decision to withhold or withdraw life-sustaining treatment. Results: This study included 122 adult critically ill patients. After adjusting for age and APACHE II score, patients with malignancy had 3.02 (95% CI 1.19 to 7.62) higher odds of having life-sustaining therapy withdrawn or withheld as compared to patients without active malignancy. Conclusion: Our study showed that critically ill patients with malignancy are more likely to have their life-sustaining therapy withheld or withdrawn than those without malignancy after adjusting for severity of disease. This finding may be related to a perception that critically ill patients with malignancy have worse prognosis as compared with those without malignancy.

Key Words: ethics • palliative care • cancer • advance directive • critical illness • prognosis • adult • treatment refusal

This version was published on December 1, 2009

American Journal of Hospice and Palliative Medicine®, Vol. 26, No. 6, 464-469 (2009)
DOI: 10.1177/1049909109341872


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