Cancer Research and Treatment

Special Article

The Situation of Life-Sustaining Treatment One Year after Enforcement of the Act on Decisions on Life-Sustaining Treatment for Patients at the End-of-Life in Korea: Data of National Agency for Management of Life-Sustaining Treatment: Ha Yeon Lee, Hwa Jung Kim, Jung Hye Kwon, Sun Kyung Baek, Young-Woong Won, Yu Jung Kim, Su Jin Baik, Hyewon Ryu; Cancer Res Treat. 2021;53(4):897-907. Published online June 2, 2021; DOI: https://doi.org/10.4143/crt.2021.327

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Purpose
The “Act on Hospice and Palliative Care and Decisions on Life-Sustaining Treatment for Patients at the End-of-Life” was enacted on February 3, 2016 and went into effect on February 4, 2018 in Korea. This study reviewed the first year of determination to life-sustaining treatment (LST) through data analysis of the National Agency for Management of Life-Sustaining Treatment.
Materials and Methods
The National Agency for Management of LST provided data between February 4, 2018 and January 31, 2019 anonymously from 33,549 patients. According to the forms patients were defined as either elf-determinants or family-determinants.
Results
The median age of the patient was 73 and the majority was male (59.9%). Cancer patients were 59% and self-determinants were 32.1%. Cancer patients had a higher rate of self-determinants than non-cancer (47.3% vs. 10.1%). Plan for hospice service was high in cancer patients among self-determinants (81.0% vs. 37.5%, p < 0.001). In comparison to family-determinants, self-determinants were younger (median age, 67 years vs. 75 years; p < 0.001) and had more cancer diagnosis (87.1% vs. 45.9%, p < 0.001). Decision of withholding or withdrawing of LSTs in cancer patients was higher than non-cancer patients in four items.
Conclusion
Cancer patients had a higher rate in self-determination and withholding or withdrawing of LSTs than non-cancer patients. Continued revision of the law and education of the public will be able to promote withdrawing or withholding the futile LSTs in patients at end-of-life. Further study following the revision of the law should be evaluated to change of end-of-life care.

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Factors Affecting Life-Sustaining Treatment Decisions and Changes in Clinical Practice after Enforcement of the Life-Sustaining Treatment (LST) Decision Act: A Tertiary Hospital Experience in Korea
Yoon Jung Jang, Yun Jung Yang, Hoi Jung Koo, Hye Won Yoon, Seongbeom Uhm, Sun Young Kim, Jeong Eun Kim, Jin Won Huh, Tae Won Kim, Seyoung Seo
Cancer Research and Treatment.2025; 57(1): 280. CrossRef
Issues and implications of the life-sustaining treatment decision act: comparing the data from the survey and clinical data of inpatients at the end-of-life process
Eunjeong Song, Dongsoon Shin, Jooseon Lee, Seonyoung Yun, Minjeong Eom, Suhee Oh, Heejung Lee, Jiwan Lee, Rhayun Song
BMC Medical Ethics.2024;[Epub] CrossRef
Recent Trends in the Withdrawal of Life-Sustaining Treatment in Patients with Acute Cerebrovascular Disease : 2017–2021
Seung Hwan Kim, Ji Hwan Jang, Young Zoon Kim, Kyu Hong Kim, Taek Min Nam
Journal of Korean Neurosurgical Society.2024; 67(1): 73. CrossRef
Healthcare Utilization and Supportive Care Timing in South Korean People Living With Amyotrophic Lateral Sclerosis: A Single-Center Retrospective Study
Min Seol Jang, Shin Hye Yoo, Min Sun Kim, Belong Cho, Kyae Hyung Kim, Jeongmi Shin, Inyoung Hwang, Seok-Jin Choi, Jung-Joon Sung, Sun Young Lee
Journal of Clinical Neurology.2024; 20(2): 166. CrossRef
Differences in end-of-life care patterns between types of hospice used for cancer patients: a retrospective cohort study
Il Yun, Eun-Cheol Park, Chung Mo Nam, Jaeyong Shin, Suk-Yong Jang, Sung-In Jang
BMC Palliative Care.2024;[Epub] CrossRef
Validation of the Korean Version of the Clinical Frailty Scale-Adjusted Korean Triage and Acuity Scale for Older Patients in the Emergency Department
Ho Sub Chung, Yunhyung Choi, Ji Yeon Lim, Keon Kim, Sung Jin Bae, Yoon Hee Choi, Dong Hoon Lee
Medicina.2024; 60(6): 955. CrossRef
Beyond Legal Boundaries: Public and Clinician Perspectives on Treatment Withdrawal in Infants With Poor Neurological Prognosis
In Gyu Song, Jung Lee, Min Sun Kim, Ji Weon Lee, So Yeon Jeon, Shin Hye Yoo, Hye Yoon Park
Journal of Korean Medical Science.2024;[Epub] CrossRef
Preferred versus Actual Place of Care and Factors Associated with Home Discharge among Korean Patients with Advanced Cancer: A Retrospective Cohort Study
In Young Hwang, Yohan Han, Min Sun Kim, Kyae Hyung Kim, Belong Cho, Wonho Choi, Yejin Kim, Shin Hye Yoo, Sun Young Lee
Healthcare.2023; 11(13): 1939. CrossRef
Comparison of the end-of-life decisions of patients with hospital-acquired pneumonia after the enforcement of the life-sustaining treatment decision act in Korea
Ae-Rin Baek, Sang-Bum Hong, Soohyun Bae, Hye Kyeong Park, Changhwan Kim, Hyun-Kyung Lee, Woo Hyun Cho, Jin Hyoung Kim, Youjin Chang, Heung Bum Lee, Hyun-Il Gil, Beomsu Shin, Kwang Ha Yoo, Jae Young Moon, Jee Youn Oh, Kyung Hoon Min, Kyeongman Jeon, Moon S
BMC Medical Ethics.2023;[Epub] CrossRef
Problems Related to the Act on Decisions on Life-Sustaining Treatment and Directions for Improvement
Dae Seog Heo, Shin Hye Yoo, Bhumsuk Keam, Sang Ho Yoo, Younsuck Koh
The Korean Journal of Hospice and Palliative Care.2022; 25(1): 1. CrossRef
Hospice-Palliative Medicine as a Model of Value-Based Healthcare
Dae Seog Heo, Shin Hye Yoo, Bhumsuk Keam, Keunjoo Yoo, Insun Choi, Min-Jeong Kim
Journal of Korean Medical Science.2022;[Epub] CrossRef
Will implementation of the Life-sustaining Treatment Decisions Act reduce the incidence of cardiopulmonary resuscitation?
In-Ae Song
Acute and Critical Care.2022; 37(2): 256. CrossRef
Aggressiveness of care in the last days of life in the emergency department of a tertiary hospital in Korea
Jung Sun Kim, Sun Young Lee, Min Sung Lee, Shin Hye Yoo, Jeongmi Shin, Wonho Choi, Yejin Kim, Hyung Sook Han, Jinui Hong, Bhumsuk Keam, Dae Seog Heo
BMC Palliative Care.2022;[Epub] CrossRef
Hospice Care Preferences and Its Associated Factors among Community-Dwelling Residents in China
Huijing Lin, Eunjeong Ko, Bei Wu, Ping Ni
International Journal of Environmental Research and Public Health.2022; 19(15): 9197. CrossRef
Impact of COVID-19 on the End-of-Life Care of Cancer Patients Who Died in a Korean Tertiary Hospital: A Retrospective Study
Jeongmi Shin, Yejin Kim, Shin Hye Yoo, Jin-Ah Sim, Bhumsuk Keam
The Korean Journal of Hospice and Palliative Care.2022; 25(4): 150. CrossRef
The Law Changes Behaviors: Is It Just Enough?
Dae Ho Lee
Cancer Research and Treatment.2021; 53(4): 895. CrossRef

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Original Articles

Do Korean Doctors Think a Palliative Consultation Team Would Be Helpful to Their Terminal Cancer Patients?: Hye-Young Shim, Yoon Jung Chang, Kiu-Sang Kawk, Tran Thi Xuan Mai, Jin Young Choi, Eun Mi Ahn, Hyun Jung Jho, So-Jung Park; Cancer Res Treat. 2017;49(2):437-445. Published online August 10, 2016; DOI: https://doi.org/10.4143/crt.2015.495

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Purpose
Hospice and palliative care services (HPC) are not commonly utilized in Korea; however, palliative care teams (PCTs) have been found to be effective at addressing the shortcomings in HPC. In this study, we attempted to outline unmet palliative care needs of terminal cancer patients and the potential benefits of PCTs as perceived by doctors in Korea.
Materials and Methods
We surveyed 474 doctors at 10 cancer-related academic conferences from June to November 2014 with a self-report questionnaire to assess their perceptions of end-of-life care needs and the expected effects of PCTs on caring for terminal cancer patients. Among those surveyed, 440 respondents who completed the entire questionnaire were analyzed.
Results
In all domains, fewer participants reported satisfaction with palliative care services than those reporting needs (p < 0.001). The surveyed participants also reported difficulties with a shortage of time for treatment, psychological burden, lack of knowledge regarding hospice care, lengths of stay, and palliative ward availability. Multivariate logistic regression analysis revealed that female doctors (odds ratio [OR], 2.672; 95% confidence interval [CI], 1.035 to 6.892), doctors who agreed that referring my patients to a HPC means I must give up on my patient (OR, 3.075; 95% CI, 1.324 to 7.127), and doctors who had no experience with HPC education (OR, 3.337; 95% CI, 1.600 to 7.125) were associated with higher expected effectiveness of PCT activities.
Conclusion
The PCT activities were expected to fill the doctor’s perceived unmet HPC needs of terminal cancer patients and difficulties in communications.

Citations

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Effects of tertiary palliative care on the pattern of end‐of‐life care in patients with hematologic malignancies in Korea
Dong Hyun Kim, Jeonghwan Youk, Ja Min Byun, Youngil Koh, Junshik Hong, Tae Min Kim, Inho Kim, Sung‐Soo Yoon, Shin Hye Yoo, Dong‐Yeop Shin
European Journal of Haematology.2024; 112(5): 743. CrossRef
Development and validation of impact of early integration of palliative care and oncology(IEI PCO) questionnaire: a survey for medical oncologists and nurses
Abdulrahman Abdulaziz Abdullah, Wafaa Mostafa Abd-El-Gawad, Sobhi Mostafa AboSerea, Fatma AbdelShakor Ali, Saima Ali
BMC Palliative Care.2024;[Epub] CrossRef
Patients’ Dying Process From the Point of View of Family and Hospice Team: A Qualitative Exploration of Family Member and Hospice Team Experiences With Hospice in Korea
Sooyoun K. Han, Yugyeong Eo
OMEGA - Journal of Death and Dying.2022; 86(2): 533. CrossRef
Status of palliative care education in Mainland China: A systematic review
Antonia M. Willemsen, Stephen Mason, Silja Zhang, Frank Elsner
Palliative and Supportive Care.2021; 19(2): 235. CrossRef
Effectiveness of home hospice care: a nationwide prospective observational study
Eunmi Ahn, In Gyu Song, Jin Young Choi, Hyun Jung Jho, Ilyeon Park, Suah Sung, Seohyun Shin, So Jung Park, Eun Jung Nam, Sung Hoon Jeong, Yoon Jung Chang
Supportive Care in Cancer.2020; 28(6): 2713. CrossRef
Sedation for terminally ill cancer patients
Young Saing Kim, Haa-Na Song, Jin Seok Ahn, Su-Jin Koh, Jun Ho Ji, In Gyu Hwang, Jina Yun, Jung Hye Kwon, Jung Hun Kang
Medicine.2019; 98(5): e14278. CrossRef

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Cancer Treatment near the End-of-Life Becomes More Aggressive: Changes in Trend during 10 Years at a Single Institute: Younak Choi, Bhumsuk Keam, Tae Min Kim, Se-Hoon Lee, Dong-Wan Kim, Dae Seog Heo; Cancer Res Treat. 2015;47(4):555-563. Published online February 16, 2015; DOI: https://doi.org/10.4143/crt.2014.200

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Purpose
The purpose of this study was to investigate and compare cancer treatment near the end-of-life (EOL) over a 10-year period. Materials and Methods Patients with advanced solid cancer at Seoul National University Hospital who received palliative chemotherapy and had died were enrolled. We categorized the consecutive patients according to two time periods: 2002 (n=57) and 2012 (n=206). Aggressiveness of cancer treatment near the EOL was evaluated.
Results
The median patient age was 62, and 65.4% of patients (n=172) were male. Time from the last chemotherapy to death (TCD) was found to have been significantly shortened, from 66.0 days to 34.0 days during 10 years (p < 0.001); 17% of patients received molecular targeted agents as the last chemotherapy regimen in 2012. The proportion of patients who received intensive care unit care within the last month increased from 1.8% in 2002 to 19.9% in 2012 (p < 0.001), and emergency room visits within the last month also increased from 22.8% to 74.8% (p < 0.001). Although hospice referral increased from 9.1% to 37.4% (p < 0.001), timing of referral was delayed from median 53 days to 8 days before death (p=0.004). Use of targeted agents as the last chemotherapy for over-two-regimen users was associated with shortened TCD (hazard ratio, 2.564; p=0.002). Conclusion Cancer treatment near the EOL became more aggressive over 10 years.

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Setting a Health Policy Research Agenda for Controlling Cancer Burden in Korea: Sung-In Jang, Kyoung-Hee Cho, Sun Jung Kim, Kwang-Sig Lee, Eun-Cheol Park; Cancer Res Treat. 2015;47(2):149-157. Published online September 11, 2014; DOI: https://doi.org/10.4143/crt.2013.167

Abstract PDF PubReader ePub

Purpose
The aim of study was to provide suggestions for prioritizing research in effort to reduce cancer burden in Korea based on a comprehensive analysis of cancer burden and Delphi consensus among cancer experts. Materials and Methods Twenty research plans covering 10 topics were selected based on an assessment of the literature, and e-mail surveys were analyzed using a two-round modified Delphi method. Thirty-four out of 79 experts were selected from four organizations to participate in round one, and 21 experts among them had completed round two. Each item had two questions; one regarding the agreement of the topic as a priority item to reduce cancer burden, and the other about the importance of the item on a nine-point scale. A consensus was defined to be an average lower coefficient of variation with less than 30% in importance. Results Seven plans that satisfied the three criteria were selected as priority research plans for reducing cancer burden. These plans are “research into advanced clinical guidelines for thyroid cancer given the current issue with over-diagnosis,” “research into smoking management plans through price and non-price cigarette policy initiatives,” “research into ways to measure the quality of cancer care,” “research on policy development to expand hospice care,” “research into the spread and management of Helicobacter pylori,” “research on palliative care in a clinical setting,” and “research into alternative mammography methods to increase the accuracy of breast cancer screenings.” Conclusion The seven plans identified in this study should be prioritized to reduce the burden of cancer in Korea. We suggest that policy makers and administrators study and invest significant effort in these plans.

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Qiaohua Xu, Biyun Chen, Donghui Jin, Li Yin, Yuelong Huang
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Cancer, Stress, and Ironies of Cancer Understanding in South Korea
Laura C. Nelson
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