Supportive Care in Cancer

, Volume 25, Issue 2, pp 677–685 | Cite as

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

  • Aart OsinskiEmail author
  • Gerard Vreugdenhil
  • Jan de Koning
  • Johannes G. van der Hoeven
Review Article


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.


Resuscitation orders Do-not-resuscitate orders Neoplasms Cancer Cardiopulmonary resuscitation Medical futility 


Authors’ contributions

All authors made substantial contributions to conception and design of this manuscript. All authors where involved in drafting the manuscript (mainly A. Osinski and G. Vreugdenhil) and revising it critically for important intellectual content. All authors have given final approval of the version to be published. Each author participated sufficiently in the work, to take public responsibility for appropriate portions of the content, and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Authors’ information

AO is a resident internal medicine, working at Maxima Medical Centre in Veldhoven, the Netherlands.

GV is an internist-oncologist working at Maxima Medical Centre, in Veldhoven, and Maastricht University Medical Centre, in Maastricht, the Netherlands.

JK is an internist-intensivist working at Maxima Medical Centre in Veldhoven, the Netherlands.

JH is a professor of intensive care medicine at Radboud University Medical Centre in Nijmegen, the Netherlands.

Compliance with ethical standards

Ethical approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Availability of supporting data

All data used writing this manuscript van be found in the reference list and are publicly available. No other datasets or materials were used writing this manuscript.

Competing interests

The authors declare that they have no competing interests.


Not applicable.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Aart Osinski
    • 1
    Email author
  • Gerard Vreugdenhil
    • 1
    • 2
  • Jan de Koning
    • 3
  • Johannes G. van der Hoeven
    • 4
  1. 1.Department of Internal MedicineMaxima Medical CentreVeldhoventhe Netherlands
  2. 2.Department of OncologyMaastricht University Medical Centre +Maastrichtthe Netherlands
  3. 3.Department of Intensive Care MedicineMaxima Medical CentreVeldhoventhe Netherlands
  4. 4.Department of Intensive Care MedicineRadboud University Medical CentreNijmegenthe Netherlands

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