Table 2.

Initial treatment for lung cancer shortly after diagnosis^a

Patient number	Tumor stage	Treatment modality S, surgery; R, radiationb; C, chemotherapy; N, none	Survival (months)c	Select excerpts on decision-making from healthcare providers’ notes
1	I	S	51+	—
2	IV	N	51	‘Atrial flutter and hypotension… arrives to the floor intubated and sedated.’
3	IV	N	5	‘Quite immediately, the patient informed me that he was not interested in active treatment for his cancer, not interested in chemotherapy or radiation therapy.’
4	I	N	4	‘Her FEV1 is 1.0, her saturation on room air goes down to 85 on exercise.’
5	I	S	30	—
6	III	N	6	‘Chemotherapy or a combined approach will be difficult given his ongoing infection.’
7	I	S	207+	—
8	III	R	3+	‘Due to the patient’s complicating medical problems with schizophrenia… and the fact that he lives alone in a halfway house, I do not think that he is a candidate for systemic chemotherapy.’ ‘The main problem appears to be his inability to cope with or understand his disease and this is, in no small part, due to his background of psychotic disorder.’
9	Unknown	S	108	—
10	III	C, R	20	—
11	I (2 Con- current pri- maries)	S	77	—
12	Unknown	N	< 1	‘Admitted for change in mental status, fever, and increased lethargy for 2 days’ ‘Talked with conservator about patient’s current state and grim prognosis with lung cancer and pneumonia. Agrees to comfort care only.’
13	III	C, R	13	—
14	III	N	< 1+	‘She has a large effusion that is negative on cytology… . She has schizophrenia and has been in a nursing home for >30 years. I really think that a thoracotomy may not be indicated ethically.’ ‘Chemotherapy… may not offer anything other than toxicity.’
15	I	R	6	‘Status post frontal lobotomy…’ ‘A difficult problem… he does not know where he is, does not know what he is here for… . There may be a moral dilemma here.’ ‘A complete schedule [for radiation] will be given to the State Hospital Staff who accompany him.’
16	I	S	187	—
17	IV	N	1	‘When asked if I believed the malignant problem is curable, I said relatively unlikely… . Not sure he wants to pursue any… treatment.’
18	IV	N	1	‘Spoke to guardian … explained incurability of metastatic non-small cell lung cancer, complicated by aspiration pneumonia and schizophrenia….[he] agrees [the patient] should be made comfortable and palliative care is proper.’
19	IV	N	< 1	‘[The oncologist] discussed patient’s diagnosis with her and her family and she is agreeable to chemotherapy.’ (Patient died prior to appointment.)
20	IV	C, R	13+	—
21	III	R	14	‘The patient has refused chemotherapy in the past and one more time told me that she is not interested in obtaining chemotherapy.’
22	II	S	22	—
23	IV	N	3+	‘Spoke with patient again as well as the patient’s son about radiation to the left femur. She repeatedly refuses consideration of treatment.’ ‘She refuses all treatment and does not believe she has cancer in her body.’
24	Limited	C, R	13	—
25	Extensive	N	< 1+	‘Patient seems alert, appropriate, and [he] fully understands the implications of ‘no treatment’. He declines chemotherapy and accepts the inevitability of progressive disease.’
26	Limited	C, R	11+	—
27	Limited	C, R	17	—
28	Limited	C, R	60+	—
29	Extensive	C, R	2+	—

^aPatients 1–23 had non-small cell lung cancer, and patients 24–29 had small cell lung cancer.

^bRadiation was given to patients with potentially curable tumors with curative intent; otherwise, it was palliative.

^cPlus sign denotes censoring.