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September 1987

Cancer and Resuscitation: Does the Diagnosis Affect the Decision?

Author Affiliations

From the Divisions of General Internal Medicine and Oncology, Department of Medicine, University of Texas Health Science Center at San Antonio and the Audie L. Murphy Memorial Veterans Hospital, San Antonio.

Arch Intern Med. 1987;147(9):1637-1640. doi:10.1001/archinte.1987.00370090113019

• We asked if physicians are less likely to resuscitate patients with cancer because of the diagnostic label alone. We composed a questionnaire of nine patient vignettes with similar expected mortality rates, identical quality of life, and witnessed cardiopulmonary arrest. Internists and neurologists in a university training program were asked to decide, for each "patient," whether to administer cardiopulmonary resuscitation (CPR) before and after being informed of similar mortality rates. Decisions for CPR were less frequent for cancer vignettes than for vignettes of other chronic medical illnesses before and after mortality information was given. Analysis indicated that decisions varied among physicians according to their subspecialties. Overall, women favored resuscitation less often than did men. The diagnosis of cancer appears to have a negative impact on physicians' CPR decisions over and above that due to inaccurate prognostic assumptions about cancer. A physician's subspecialty and gender may also influence resuscitation decisions for patients in general.

(Arch Intern Med 1987;147:1637-1640)