scholarly journals Perubahan Status Koagulasi Pasien Kanker Padat Pasca Kemoterapi di Indonesia: Sebuah Studi Prospektif

2020 ◽  
Vol 7 (1) ◽  
pp. 2
Author(s):  
Noorwati Sutandyo ◽  
Lyana Setiawan
Keyword(s):  
Cancer Patients ◽  
Prospective Cohort ◽  
Stage Iv ◽  
Stage Iii ◽  
Solid Cancer ◽  
Significant Difference ◽  
Before And After ◽  
Coagulation Status ◽  
Stage Iv Cancer ◽  
D Dimer

Pendahuluan. Hiperkoagulasi merupakan faktor yang mendasari tingginya mortalitas akibat kejadian tromboemboli vena pada pasien kanker. Kemoterapi merupakan salah satu faktor yang diduga berkontribusi terhadap status hiperkoagulasi pada pasien kanker. Studi ini bertujuan untuk mengevaluasi perubahan status koagulasi yang ditandai dengan kadar D-dimer pada pasien kanker yang menjalani kemoterapi.Metode. Studi ini merupakan studi kohort prospektif di Pusat Kanker Nasional Indonesia yang melibatkan pasien kanker yang sudah terkonfirmasi melalui pemeriksaan histopatologi, dan memulai kemoterapi pada periode Mei hingga Juli 2018. Perubahan status koagulasi dinilai melalui kadar D-dimer plasma. Kadar D-dimer diukur sebelum dan 7 hari setelah kemoterapi. Analisis statistik menggunakan uji t berpasangan untuk menilai kemaknaan perubahan kadar D-dimer plasma sebelum dan setelah kemoterapi.Hasil. Sejumlah 89 pasien memenuhi kriteria inklusi, yang mana 74,2% adalah perempuan dan hampir separuh dari keseluruhan subjek terdiagnosis kanker payudara (44,9%). Mayoritas subjek (69,6%) terdiagnosis pada stadium III atau IV. Sejumlah 12,4% dari subjek mendapatkan kemoterapi berbasis cisplatin. Terdapat perbedaan yang bermakna antara kadar D-dimer sebelum dan setelah kemoterapi (p = 0,05). Studi ini juga menemukan perbedaan bermakna kadar D-dimer sebelum dan sesudah kemoterapi pada pasien kanker stadium III (t(35) = 2,48, p = 0,02) dan stadium IV (t(25) = 2,14, p = 0,04). Tidak terdapat perbedaan bermakna antara kadar D-dimer sebelum dan setelah kemoterapi pada pasien stadium I dan II. Analisis lanjutan berdasarkan kelompok kemoterapi menunjukkan bahwa terdapat perubahan kadar D-dimer yang bermakna pada kelompok yang mendapatkan kemoterapi cisplatin (t(10) = 2,31, p = 0,04), namun tidak pada kelompok yang mendapat kemoterapi non-cisplatin (t(77) = 1,50, p = 0,14).Simpulan. Terdapat perbedaan bermakna status koagulasi yang ditandai dengan kadar D-dimer 7 hari pasca mendapatkan kemoterapi, khususnya pada pasien kanker stadium III atau IV dan mendapatkan kemoterapi berbasis cisplatin. Kata Kunci: Cisplatin, kanker, kemoterapi, status koagulasiChange of Coagulation Status in Solid Cancer Patients Undergoing Chemotherapy in Indonesia: A Prospective Cohort StudyIntroduction. Cancer-associated hypercoagulability was an underlying factor of high mortality of cancer due to venous thromboembolism. Chemotherapy is proposed as one of the contributing factors of the hypercoagulable state. We aim to evaluate the change of coagulation status, which was marked by D-dimer level, in cancer patients receiving chemotherapy.Methods. This is a prospective cohort study in Indonesian national cancer center which involves all adult histologically-confirmed-cancer patients who started chemotherapy between May and July 2018. The coagulation status is assessed by plasma of D-dimer level. We measured D-dimer before chemotherapy and one week after chemotherapy. Paired t-test was performed to assess the significant difference in D-dimer levels before and after chemotherapy.Results. A total of 89 patients fulfilled the eligibility criteria, of whom 74.2% were female and almost half of total subjects (44.9%) were breast cancer patients. Majority of subjects (69.6%) were stage III or stage IV cancer. There were 12.4% of subjects received cisplatin-based chemotherapy. There was a marginally significant difference in plasma level of D-dimers before and after chemotherapy (p = 0.05). We also found significant differences between D-dimer level before and after chemotherapy in stage III patients (t(35) = 2.48, p = 0.02) and stage IV patients (t(25) = 2.14, p = 0.04). There was no significant difference between D-dimer level before and after chemotherapy in stage I and stage II patients. Subgroup analyses based on chemotherapy agents showed that there was significant D-dimer change in cisplatin-based chemotherapy subjects (t(10) = 2.31, p = 0.04), but not in non-cisplatin-based chemotherapy subjects (t(77) = 1,50, p = 0.14).Conclusion. Compared to before chemotherapy, there is a significant difference of coagulation status marked by plasma D-dimer level one week after chemotherapy, particularly in patients with stage III or stage IV cancer and in patients receiving cisplatin-based chemotherapy.

Aggressive care at the end of life: A study of practice based factors in patients with stage IV cancer.

2017 ◽  
Vol 35 (8_suppl) ◽  
pp. 80-80
Author(s):  
Mohammad Omar Atiq ◽  
Rahul Ravilla ◽  
Ajay Kumar ◽  
Sajjad Haider ◽  
Ji-Ling Tang ◽  
...  
Keyword(s):  
Palliative Care ◽  
Length Of Stay ◽  
End Of Life ◽  
Cancer Patients ◽  
Stage Iv ◽  
Goals Of Care ◽  
Significant Difference ◽  
Aggressive Care ◽  
Stage Iv Cancer ◽  
End Stage

80 Background: Numerous studies established that early utilization of palliative care-hospice services are beneficial to cancer patients. To reduce the incidence of aggressive care in terminal cancer patients, we conducted a quality improvement study to identify pertinent risk factors and develop interventions. Methods: Through chart review, we retrospectively identified patients with stage IV cancer that were followed by oncology clinic and were admitted to the University Hospital between 8/1/2015-10/31/15. For those patients who died during the last hospitalization or were discharged to hospice care, we obtained demographic, cancer related and practice related variables listed in Table. We used Mann Whitney U test and multivariable regression to find effects of factors related to length of stay (LOS) and cost of stay (COS). Results: Length of stay was significantly prolonged in those receiving chemotherapy within the past month (6 vs 3 p=0.035). Multivariate analyses found that patients with goals of care documented in the clinic had lower COS by 36.7% and LOS by 46.7%. On average, an ICU stay resulted in COS 2.2 times higher. No significant difference was seen in LOS based on a documented palliative care clinic visit or presence of an advanced directive. Conclusions: We identified practice based factors that need improvement including earlier goals of care conversations and less chemotherapy at the end of life. Identifying end stage patients in earlier admissions, collaborating with palliative care, and adding goals of care documentation to clinic note templates, are all interventions we are studying to improve care for end stage cancer patients. [Table: see text]

The predictive value of hENT 1 molecule for gemcitabine treatment in bladder cancer.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e15540-e15540
Author(s):  
Didem Sener Dede ◽  
Aydan Kilicaslan ◽  
Muhammed Bulent Akinci ◽  
Umut Demirci ◽  
Gozde Tahtaci ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Cancer Patients ◽  
Predictive Value ◽  
Stage Iv ◽  
Response To Therapy ◽  
Stage Iii ◽  
Low Grade ◽  
Nucleoside Transporter ◽  
Control Tissue ◽  
Significant Difference

e15540 Background: Human equilibrative nucleoside transporter 1 (hENT1) is the nucleoside transporter protein which plays the main role for transportation of gemcitabine into the cells. We aim to assess the predictive value of the hENT 1 molecule in bladder cancer patients treated with gemcitabine based chemoterapy. Methods: Clinically and histologically documented stage III and stage IV invazive bladder cancer patients were included in the study. The patients were assessed retrospectively. All patients were received gemsitabine-platine based chemotherapy as the first line treatment. Spesific hENT1 antibody staining was performed on the chemo-naive bladder tumor specimens immunuhistochemically. Vascular endotel and lymphocytes served as an external positive control for hENT 1 immunuhistochemistry. Staining intensity was graded as 0,absent; 1+, less intens than control tissue, 2, equally positive as control tissue; 3, more intense than control tissue. Tumor spesimens with having 3+ intensity staining in >50% of the tumor cells were accepted as showing high expression of hENT 1. Results: Fifty one patients were included in the study. The median age was 67 (range 41-85). Ninety two percent(n=52) of patients were male. Twenty six (46.4%) and 25 (44.6%) patients were stage III and stage IV disease at the beginning of the therapy, respectively. Thirty four (60.7%) patients were in neoadjuvant treatment group and 17 (30.4%) patients were in metastatic group. Tumor grades could be assessed in 33 patients; 2 (11.4%) were low grade and 31 (88%) were high grade. The median folllow up period was 13 (range 1-58) months. In neoadjuvant group 5 (14%) patients have low hENT 1 level and 21 (60%) patients have high hENT 1 level. In metastatic group 1 (5%) patients have low hENT1 level and 13 (95%) patients have high hENT 1 level. We found no statistically significant difference between hENT 1 low and hENT 1 high groups in terms of response to therapy in metastatic and neoadjuvant groups (p=0.426 and p=0.684 respectively). Conclusions: More stuides are needed to demonstrate the real role of hENT 1 molecule in terms of response to gemsitabine treatment.

Hemostasis in Newly Diagnosed Multiple Myeloma Patients before and after Induction Therapy

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 5388-5388
Author(s):  
Evdokia S. Urnova ◽  
Larisa P. Mendeleeva ◽  
Olga S. Pokrovskaya ◽  
Marina A. Gracheva ◽  
Eduard G. Gemdzhian ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Induction Therapy ◽  
Stage Iii ◽  
Normal Rate ◽  
Newly Diagnosed ◽  
Complex Disorders ◽  
Significant Difference ◽  
Before And After ◽  
The Status ◽  
D Dimer

Abstract Background: Course of multiple myeloma (MM) is associated with hemostatic disorders that can lead to bleeding or thrombosis. According to previous studies the most risky period of time for thrombotic complication is the first year after diagnosis. Aims: The study was aimed to analyze of hemostasis conditions in newly diagnosed (ND) MM patients (pts) and to compare their initial status with the status after induction therapy (IT) and with the status of healthy volunteers (HV). Patients and Methods: 17 pts with ND MM: 10 males, 7 females at the age of 26-72 (median age - 54) were involved in the study. The distribution of the stages among the participants according to Durie-Salmon system: stage I - 1 pts, stage II - 5 pts, stage III - 8 pts, stage III in 8 pts. Immunochemistry variants: IgG - 11 pts, IgA - 2 pts, MM B-J - 4 pts. Average paraprotein (PP) level was 34g/L (0,8 - 78). HV group consisted of 26 persons without serious diseases, 40 - 70 y.o., (median age 50). Hemostasis analysis was taken place twice: before and after the IT which included 4-8 bortesomib-containing cycles (PAD, VCD, VD). After the IT 6 pts achieved CR, 5 pts - VGPR, 4 pts - PR and 1pt was resistant. Average value of PP decreased to 8 (0,1 - 29,7). Routine tests: activated partial thromboplastin time (APTT, normal rate 25-38 sec), international normalized ratio (INR, normal rate 0.85-1.15), D-dimer concentration (normal rate 0-500 mkg/l). Two global tests: thrombin generation test by using endogenous thrombin potential (ETP, normal rate 760-1450 nM*min) and thrombodinamics (TD), characterized by the initial clot growth velocity (Vi, normal rate 36-56 um/min), stationary velocity (Vst, normal rate 20-30um/min), and density of a fibrin clot measured by light scattering from clot (D, normal rate 16000 - 32000 conventional units). Hypocoagulability wasassessedby data APTT > 38 sec, INR> 1.15, ETP < 760 nM*min, Vi < 36 um/min, Vst < 20 um/min, D < 16000 cu. Hypercoagulability was considered in cases when APTT < 25 sec, INR < 0,85, D-dimer > 500 ng/ml, ETP > 1450 nM*min, Vi > 56 um/min, Vst > 30 um/min, D > 32000 cu. Statistics. Ðaired t-test and Pearson correlation coefficient (r) have been got with SAS 9.1. 95- percent CI has been used. Results: ND MM APTT evaluation demonstrated normal coagulation in 13pts and extended one in 4pts (48 sec [38-57]). INR was normal in 13 and increased in 4 cases (1.3% [1.2-1.5]). Increased concentration of D-dimer was revealed in 7pts (3810 ng/ml [350-7270]). ETP was normal in 12 and increased in 5 cases (1592 nM*min [1406-1779]). Vi was normal in 11 and increased in 6pts (62 um/min [58-65])). Vst was reduced in 1pts (15um/min), normal in 10pts and increased in 6pts (36um/min [28-44]). Density of clot was normal in 8 pts and decreased in 9pts (9769 UE [6379-13160]). (Tab. 1) After IT only 1 pt had elongated APTT (44sec), the results of the others were normal. INR was normal in all cases. D-dimer concentration was normal in 12pts and increased in 5pts, but this data was statistically less (1080ng/ml [500-1003]) than in ND MM. ETP was normal in 13pts, elevated in 4 pts (1604 nM*min [1099-2109]). Vi was normal in 12pts and increased in 4pts (61 um/min [57-65]). Vst was decreased in 2pts (13 and 14um/min), normal in 13pts and increased in 2 (32 and 43um/min). Density of clot became normal in 14pts, but clot remained not dense enough in 3 pts (9512 [13606-15779]). (Tab. 1) We found that inverse linear relationship between PP level and blood clot density was more significant in ND MM (Fig. 1, fig.2). Statistically significant difference was revealed between clot density in ND MM and pts in PR or CR and between them and HV (Fig. 3). Furthermore, a significant difference was identified between D-dimer concentration in ND MM pts and after IT (Fig. 4). Conclusions: MM pts have complex disorders of hemostasis characterized by a tendency to hyper- and hypocoagulation at the same time. In spite of an increased tendency to thrombosis confirmed by D-dimer, ETP, TD, pts are under risk of bleeding related to the formation of defective clot and elongated APTT. According to the obtained results one can assume that PP embedded in the clot and disorder its structure. However, further studies are needed to confirmthat assertion. Figure 2. Figure 2. Figure 3. Figure 3. Disclosures No relevant conflicts of interest to declare.

Exploratory Study of Advance Care Discussions Among Chinese American and White Stage IV Cancer Patients at an American Tertiary Medical Center

2021 ◽  
pp. 104990912110126
Author(s):  
Avery Caz Glover ◽  
Courtney Schroeder ◽  
Emma Ernst ◽  
Tamara Vesel
Keyword(s):  
Cancer Patients ◽  
Exploratory Study ◽  
Stage Iv ◽  
Chinese American ◽  
Chinese Americans ◽  
Do Not Resuscitate ◽  
Essential Components ◽  
Advance Care ◽  
Stage Iv Cancer ◽  
White Patients

Purpose: Timely advance care discussions are essential components of quality care for diverse populations; however, little is known about these conversations among Chinese American cancer patients. This exploratory study describes differences in advance care discussions and planning between Chinese American and White advanced cancer patients. Methods: We collected data for 63 Chinese American and 63 White stage IV cancer patients who died between 2013 and 2018. We compared: frequency and timing of prognosis, goals of care (GOC), and end-of-life care (EOLC) discussions in the final year of life; family inclusion in discussions; healthcare proxy (HCP) identification; do not resuscitate (DNR) order, do not intubate (DNI) order, and other advance directive (AD) completion. We did not conduct statistical tests due to the study’s exploratory nature. Results: Among Chinese American and White patients, respectively, 76% and 71% had prognosis, 51% and 56% had GOC, and 89% and 84% had EOLC discussions. Prognosis, GOC, and EOLC discussions were held a median of 34.0, 15.5, and 34.0 days before death among Chinese American and 17.0, 13.0, and 24.0 days before death among White patients. Documentation rates among Chinese American and White patients were 79% and 76% for DNRs, 81% and 71% for DNIs, 79% and 81% for HCPs, and 52% and 40% for other ADs. Conclusions: Findings suggest that Chinese Americans had similar rates of advance care discussions, completed conversations earlier, and had similar to higher rates of AD documentation compared to White patients. Further studies are needed to confirm our preliminary findings.

scholarly journals EFFECT OF MINDFULNESS INTERVENTION ON THE INTENSITY OF PAIN IN NASOPHARINGEAL CANCER PATIENTS UNDERGOING RADIATION TREATMENT

2018 ◽  
Vol 4 (2) ◽  
pp. 195-201
Author(s):  
Anna Jumatul Laely ◽  
Awal Prasetyo ◽  
Chandra Bagus Ropyanto
Keyword(s):  
Cancer Patients ◽  
Radiation Treatment ◽  
Nasopharyngeal Cancer ◽  
Psychological Trauma ◽  
Control Group ◽  
Intensity Level ◽  
Control Group Design ◽  
Mindfulness Intervention ◽  
Significant Difference ◽  
Before And After

Background: Physical responses that occur in patients with nasopharyngeal cancer are the emergence of pain due to the effects of treatment. The problem of pain in these patients at the stage of treatment remains critical to solve because it can cause comorbidity, psychological trauma and mortality. Mindfulness intervention is considered useful in transforming consciousness into the stage of acceptance.Objective: This study aims to determine the effect of mindfulness intervention on the intensity of pain in nasopharyngeal cancer patients undergoing radiation treatment.Methods: This was a quasy-experimental study with pretest posttest control group design. Thirty patients were selected using consecutive sampling, which divided into experiment and control group. Visual Analogue Scale (VAS) was used to measure pain. Each respondent received mindfulness intervention for 6 sessions, divided into 3 meetings. Paired t-test was used for data analysis.Results: The results showed a significant reduction of pain from 4.12 (moderate pain) to 3.06 (mild pain) in the experiment group. There was a significant difference in pain level before and after mindfulness intervention (p= 0.001).Conclusion: Mindfulness is effective in reducing pain intensity level in nasopharyngeal cancer patients undergoing radiation therapy.

scholarly journals The Effect of the Covid-19 Free Operation Path Protocol on the Incidence of Lung Complications in Postoperative Elective Patients at dr. Moewardi Hospital Surakarta

2021 ◽  
Vol 5 (11) ◽  
pp. 1030-1036
Author(s):  
Galih Aktama ◽  
Henky Agung Nugroho ◽  
Muhammad David Perdana Putra
Keyword(s):  
Cancer Patients ◽  
Elective Surgery ◽  
Pulmonary Complications ◽  
P Value ◽  
Chi Square ◽  
Elective Surgical Procedures ◽  
Significant Difference ◽  
Before And After ◽  
Chi Square Test ◽  
Elective Patients

The pandemic that began in late 2019, COVID-19, affects all patients, including cancer patients. Patients with cancer that continues to spread and  there is no other effective alternative treatment must undergo surgery so that cancer does not get worse. Given this problem, many health care centers have developed a protocol system in the form of a COVID-19-free surgical route. This study is a retrospective cohort study comparing the incidence of pulmonary complications in patients undergoing elective cancer surgery at dr. Moewardi Surakarta before and during the COVID-19 pandemic. The study sample was adult patients  aged ≥ 18 years which underwent elective surgical procedures with the aim of curative cancer starting before COVID-19 (March 2019-February 2020) until the time the COVID-19 pandemic emerged (March 2020 - February 2021). The data obtained were 768 patients. Of these patients, 384 were classified as having a COVID19-free operation route during the pandemic, and 384 others underwent elective surgery in the pre-pandemic period. Based on the Chi-Square test, a p-value of 0.850 was obtained (P>0.05) which shows that there is significant difference between cases of pulmonary complications in surgical patients before and after the pandemic who were carried out through the COVID-19-free protocol route. In conclusion, there is no significant change in effect of the covid-19 free operation path protocol on the incidence of lung complications in postoperative elective patients at dr. Moewardi Hospital Surakarta, although this patented and mandatory protocol can reduce cancer patients’ morbidity and mortality who undergoing elective surgery during a pandemic.

scholarly journals Comparison of common risk stratification indices to predict outcomes among stage IV cancer patients with bowel obstruction undergoing surgery

2017 ◽  
Vol 117 (3) ◽  
pp. 479-487 ◽  
Author(s):  
Sarah B. Bateni ◽  
Richard J. Bold ◽  
Frederick J. Meyers ◽  
Daniel J. Canter ◽  
Robert J. Canter
Keyword(s):  
Risk Stratification ◽  
Cancer Patients ◽  
Bowel Obstruction ◽  
Stage Iv ◽  
Stage Iv Cancer

scholarly journals Report of clinico-pathological features of breast cancer in HIV-infected and uninfected women in Botswana

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Rohini K. Bhatia ◽  
Mohan Narasimhamurthy ◽  
Yehoda M. Martei ◽  
Pooja Prabhakar ◽  
Jeré Hutson ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Stage Iii ◽  
Disease Stage ◽  
Breast Cancers ◽  
Pathological Features ◽  
Breast Cancer Patients ◽  
Hiv Status ◽  
Receptor Status ◽  
Significant Difference

Abstract Background To characterize the clinico-pathological features including estrogen receptor (ER), progesterone receptor (PR) and Her-2/neu (HER2) expression in breast cancers in Botswana, and to compare them by HIV status. Methods This was a retrospective study using data from the National Health Laboratory and Diagnofirm Medical Laboratory in Gaborone from January 1, 2011 to December 31, 2015. Clinico-pathological details of patients were abstracted from electronic medical records. Results A total of 384 unique breast cancer reports met our inclusion criteria. Of the patients with known HIV status, 42.7% (50/117) were HIV-infected. Median age at the time of breast cancer diagnosis was 54 years (IQR 44–66 years). HIV-infected individuals were more likely to be diagnosed before age 50 years compared to HIV-uninfected individuals (68.2% vs 23.8%, p < 0.001). The majority of patients (68.6%, 35/51) presented with stage III at diagnosis. Stage IV disease was not presented because of the lack of data in pathology records surveyed, and additionally these patients may not present to clinic if the disease is advanced. Overall, 68.9% (151/219) of tumors were ER+ or PR+ and 16.0% (35/219) were HER2+. ER+ or PR+ or both, and HER2- was the most prevalent profile (62.6%, 132/211), followed by triple negative (ER−/PR−/HER2-, 21.3%, 45/211), ER+ or PR+ or both, and HER2+, (9.0%, 19/211) and ER−/PR−/HER2+ (7.1%, 15/211). There was no significant difference in receptor status noted between HIV-infected and HIV-uninfected individuals. Conclusions Majority of breast cancer patients in Botswana present with advanced disease (stage III) at diagnosis and hormone receptor positive disease. HIV-infected breast cancer patients tended to present at a younger age compared to HIV-uninfected patients. HIV status does not appear to be associated with the distribution of receptor status in breast cancers in Botswana.

Advance Directive and Do-Not-Resuscitate Status among Advanced Cancer Patients with Acute Care Surgical Consultation

2018 ◽  
Vol 84 (10) ◽  
pp. 1565-1569
Author(s):  
Lobsang Marcia ◽  
Zane W. Ashman ◽  
Eric B. Pillado ◽  
Dennis Y. Kim ◽  
David S. Plurad
Keyword(s):  
Length Of Stay ◽  
Cancer Patients ◽  
Acute Care ◽  
Metastatic Cancer ◽  
Stage Iv ◽  
Acute Care Surgery ◽  
Do Not Resuscitate ◽  
Stage Iv Cancer ◽  
Care Surgery ◽  
Dnr Orders

Formal communication of end-of-life preferences is crucial among patients with metastatic cancer. Our objective is to describe the prevalence of advance directives (AD) and do-not-resuscitate (DNR) orders among stage IV cancer patients with acute care surgery consultations, and the associated outcomes. This is a single institution retrospective review over an eight-year period. Two hundred and three patients were identified; mean age was 55.3 ± 11.4 years and 48.8 per cent were male. Fifty (24.6%) patients underwent exploratory surgery. Nineteen (10.6%) patients had another type of surgery. Twenty-one (10.3%) patients had a DNR order, and none had an AD on-admission. Fifty-four (26.6%) patients had a DNR order placed and four (2%) patients completed an AD postadmission. DNR postadmission was associated with the highest mortality at 42.6 per cent compared with 14.3 per cent for DNR on-admission and 1.56 per cent for full-code patients ( P < 0.001). Compared with patients that remained full-code and those with DNR on-admission, DNR postadmission was associated with longer length of stay (19.6 days; P < 0.001) and ICU length of stay (7.72 days; P < 0.001). The prevalence of AD and DNR orders among stage IV cancer patients is low. The higher in-hospital mortality of patients with DNR postadmission reflects the use of DNR orders during clinical decline.

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