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Management of Physical Symptoms in Patients with Advanced Cancer during the Last Weeks and Days of Life
Ahsan Azhar, David Hui
Cancer Res Treat. 2022;54(3):661-670.   Published online June 30, 2022
DOI: https://doi.org/10.4143/crt.2022.143
AbstractAbstract PDFPubReaderePub
Patients with advanced cancer are faced with many devastating symptoms in the last weeks and days of life, such as pain, delirium, dyspnea, bronchial hypersecretions (death rattle) and intractable seizures. Symptom management in the last weeks of life can be particularly challenging because of the high prevalence of delirium complicating symptom assessment, high symptom expression secondary to psychosocial and spiritual factors, limited life-expectancy requiring special considerations for prognosis-based decision-making, and distressed caregivers. There is a paucity of research involving patients in the last weeks of life, contributing to substantial variations in clinical practice. In this narrative review, we shall review the existing literature and provide a practical approach to in-patient management of several of the most distressing physical symptoms in the last weeks to days of life.

Citations

Citations to this article as recorded by  
  • Comparing the use of aggressive end-of life care among frail and non-frail patients with cancer using a claims-based frailty index
    Rishi Sachdev, Galen Shearn-Nance, Long Vu, Wyatt P. Bensken, Sara L. Douglas, Siran M. Koroukian, Johnie Rose
    Journal of Geriatric Oncology.2024; 15(2): 101706.     CrossRef
  • 6,669 View
  • 179 Download
  • 1 Web of Science
  • 1 Crossref
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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
AbstractAbstract PDFSupplementary MaterialPubReaderePub
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.

Citations

Citations to this article as recorded by  
  • 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
  • 8,042 View
  • 211 Download
  • 15 Web of Science
  • 16 Crossref
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Original Articles
Palliative medicine
A National Study of Life-Sustaining Treatments in South Korea: What Factors Affect Decision-Making?
So-Youn Park, Bomyee Lee, Jeong Yeon Seon, In-Hwan Oh
Cancer Res Treat. 2021;53(2):593-600.   Published online November 21, 2020
DOI: https://doi.org/10.4143/crt.2020.803
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Purpose
This cross-sectional study investigated the status of life-sustaining treatment (LST) practices and identified characteristics and factors influencing decision-making practices.
Materials and Methods
The National Agency for Management of Life-sustaining Treatment retains records provided by doctors regarding patients subject to LST implementation. A total of 71,327 patients receiving LST were identified. We analyzed all nationally reported data between February 2018 and October 2019. Indicators such as the proportion of deaths, records for decision to terminate LST, implementation of LST records, and registration of Advance Statements on LST were analyzed.
Results
A total of 67,252 (94.3%) end-of life decisions were implemented in South Korea. The proportion of deaths preceded by a LST plan, non-self-determination LST decision, and any advance statements was 33.5% (23,891/71,327), 66.5% (47,436/71,327), and 1.2% (890/71,327), respectively. The logistic regression model revealed that self-determination to terminate LST was more frequent for men than for women and higher for those aged 30-69. Disability (odds ratio [OR], 0.59; 95% confidence interval [CI], 0.56 to 0.61), living in non-metropolitan areas (OR, 0.84; 95% CI, 0.81 to 0.86), and disease comorbidity was independently associated with a low level of self-determination.
Conclusion
After the implementation of the new LST Act, about a third of patients in end-of-life process made decisions regarding their medical LST. However, family members still play a major role in LST decisions where the patient’s intention cannot be verified. Decisions related to LST are predominantly made when death is imminent. Thus, it is necessary to increase awareness of end-of-life LST decision-making among medical staff and the public.

Citations

Citations to this article as recorded by  
  • 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
  • Characteristics of Life-Sustaining Treatment Decisions: National Data Analysis in South Korea
    Jiyeon Choi, Heejung Jeon, Ilhak Lee
    Asian Bioethics Review.2024; 16(1): 33.     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
  • The Impact of Withdrawing or Withholding of Life-Sustaining Treatment: A Nationwide Case-Control Study Based on Medical Cost Analysis
    Claire Junga Kim, Do-Kyong Kim, Sookyeong Mun, Minkook Son
    Journal of Korean Medical Science.2024;[Epub]     CrossRef
  • Characteristics and outcomes of patients with do-not-resuscitate and physician orders for life-sustaining treatment in a medical intensive care unit: a retrospective cohort study
    Song-I Lee, Ye-Rin Ju, Da Hyun Kang, Jeong Eun Lee
    BMC Palliative Care.2024;[Epub]     CrossRef
  • Clinical Characteristics and Prognosis of Older Patients with Coronavirus Disease 2019 Requiring Mechanical Ventilation
    Green Hong, Da Hyun Kang, Sunghoon Park, Su Hwan Lee, Onyu Park, Taehwa Kim, Hye Ju Yeo, Jin Ho Jang, Woo Hyun Cho, Song I Lee
    Journal of Personalized Medicine.2024; 14(6): 657.     CrossRef
  • Comparison of factors influencing the decision to withdraw life-sustaining treatment in intensive care unit patients after implementation of the Life-Sustaining Treatment Act in Korea
    Claire Junga Kim, Kyung Sook Hong, Sooyoung Cho, Jin Park
    Acute and Critical Care.2024; 39(2): 294.     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
  • Psychosocial Factors Associated With Thoughts Regarding Life-Sustaining Treatment for Oneself and Family Members
    Jeewon Lee, Shin-Gyeom Kim, Soyoung Irene Lee, HyunChul Youn
    Psychiatry Investigation.2024; 21(6): 646.     CrossRef
  • Emergency department and intensive care unit health professionals' knowledge and application of the law that applies to end-of-life decision-making for adults: A scoping review of the literature
    Jayne Hewitt, Nemat Alsaba, Katya May, Halima Sadia Noon, Cooper Rennie, Andrea P. Marshall
    Australian Critical Care.2023; 36(4): 628.     CrossRef
  • Decision and Practice of End-of-Life Care in Lung Disease Patients with Physicians Orders for Life Sustaining Treatment
    Yu Mi Oh, Yoon Na Kang, Soo Jung Han, Jeong Hye Kim
    The Korean Journal of Hospice and Palliative Care.2023; 26(1): 7.     CrossRef
  • Advance Care Planning in South Korea
    Yu Jung Kim, Sun-Hyun Kim
    Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen.2023; 180: 68.     CrossRef
  • Participation and Influencing Factors in the Decision-Making of Life-Sustaining Treatment: A Focus on Deceased Patients with Hematologic Neoplasms
    Jae Eun Jang, Jeong Moon Ryu, Min Hee Heo, Do Eun Kwon, Ji Yeon Seo, Dong Yeon Kim
    The Korean Journal of Hospice and Palliative Care.2023; 26(2): 69.     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
  • Analysis of Cancer Patient Decision-Making and Health Service Utilization after Enforcement of the Life-Sustaining Treatment Decision-Making Act in Korea
    Dalyong Kim, Shin Hye Yoo, Seyoung Seo, Hyun Jung Lee, Min Sun Kim, Sung Joon Shin, Chi-Yeon Lim, Do Yeun Kim, Dae Seog Heo, Chae-Man Lim
    Cancer Research and Treatment.2022; 54(1): 20.     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
  • Derivation and performance of an end-of-life practice score aimed at interpreting worldwide treatment-limiting decisions in the critically ill
    Spyros D. Mentzelopoulos, Su Chen, Joseph L. Nates, Jacqueline M. Kruser, Christiane Hartog, Andrej Michalsen, Nikolaos Efstathiou, Gavin M. Joynt, Suzana Lobo, Alexander Avidan, Charles L. Sprung, Wesley Ely, Erwin J. O. Kompanje, Mervyn Mer, Charles Fel
    Critical Care.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
  • The cascade of care for latent tuberculosis infection in congregate settings: A national cohort analysis, Korea, 2017–2018
    Jinsoo Min, Hyung Woo Kim, Helen R. Stagg, Molebogeng X. Rangaka, Marc Lipman, Ibrahim Abubakar, Yunhee Lee, Jun-Pyo Myong, Hyunsuk Jeong, Sanghyuk Bae, Ah Young Shin, Ji Young Kang, Sung-Soon Lee, Jae Seuk Park, Hyeon Woo Yim, Ju Sang Kim
    Frontiers in Medicine.2022;[Epub]     CrossRef
  • Preparation and Practice of the Necessary Documents in Hospital for the “Act on Decision of Life-Sustaining Treatment for Patients at the End-of-Life”
    Sun Kyung Baek, Hwa Jung Kim, Jung Hye Kwon, Ha Yeon Lee, Young-Woong Won, Yu Jung Kim, Sujin Baik, Hyewon Ryu
    Cancer Research and Treatment.2021; 53(4): 926.     CrossRef
  • 7,028 View
  • 184 Download
  • 17 Web of Science
  • 20 Crossref
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Changes of End of Life Practices for Cancer Patients and Their Association with Hospice Palliative Care Referral over 2009-2014: A Single Institution Study
Hyun Jung Jho, Eun Jung Nam, Il Won Shin, Sun Young Kim
Cancer Res Treat. 2020;52(2):419-425.   Published online September 3, 2019
DOI: https://doi.org/10.4143/crt.2018.648
AbstractAbstract PDFPubReaderePub
Purpose
In Korea, hospice palliative care (HPC) provision for cancer patients has increased recently. However, whether end of life (EoL) care practices have improved along with the development of HPC is unclear. We intended to investigate the changes in EoL care practices and their association with HPC referral. Materials and Methods Retrospective medical record review of adult cancer patients who died at National Cancer Center Korea from 1 January 2009 to 31 December 2014 was performed. Changes of EoL practices including chemotherapy within 2 weeks from death, death in intensive care unit (ICU), documentation of “do not resuscitate (DNR)” within 7 days from death and referral to HPC from 2009 to 2014 were analyzed as well as the association between referral to HPC and other practices.
Results
A total of 2,377 cases were included in the analysis. Between 2009 and 2014, referral to HPC increased and DNR documentation within 7 days from death decreased significantly. Cases for chemotherapy within 2 weeks from death and death in ICU didn’t change over the study period. Patients referred to HPC were less likely to receive chemotherapy within 2 weeks from death, die in ICU and document DNR within 7 days from death. Conclusion During the study period, EoL practices among cancer patients partly changed toward less aggressive in our institution. HPC referral was associated with less aggressive cancer care at the EoL. Policies to promote EoL discussion are necessary to improve the EoL practices of cancer patients.

Citations

Citations to this article as recorded by  
  • Decreased aggressive care at the end of life among advanced cancer patients in the Republic of Korea: a nationwide study from 2012 to 2018
    Sara Kwon, Kyuwoong Kim, Bohyun Park, So-Jung Park, Hyun Jung Jho, Jin Young Choi
    BMC Palliative Care.2024;[Epub]     CrossRef
  • Symptom burden, palliative care knowledge, and palliative care needs in advanced gynecological cancer patients in Korea
    Eungil Ko, Yaelim Lee
    Supportive Care in Cancer.2024;[Epub]     CrossRef
  • End-of-Life Decision Making in Patients with Advanced Dementia: The Perspectives of the Korean General Population and Clinicians
    So Yeon Jeon, Shin Hye Yoo, Jung Lee, In Gyu Song, Min Sun Kim, Hye Yoon Park
    Psychiatry Investigation.2024; 21(10): 1137.     CrossRef
  • Advance Care Planning in South Korea
    Yu Jung Kim, Sun-Hyun Kim
    Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen.2023; 180: 68.     CrossRef
  • Public awareness of advance care planning and hospice palliative care: a nationwide cross-sectional study in Korea
    Boram Kim, Junyong Lee, Youn Seon Choi
    BMC Palliative Care.2023;[Epub]     CrossRef
  • Prevalence and related factors of do-not-resuscitate orders among in-hospital cardiac arrest patients
    Tangxing Jiang, Yanyan Ma, Jiaqi Zheng, Chunyi Wang, Kai Cheng, Chuanbao Li, Feng Xu, Yuguo Chen
    Heart & Lung.2022; 51: 9.     CrossRef
  • Discussing POLST-facilitated hospice care enrollment in patients with terminal cancer
    Ho Jung An, Hyun Jeong Jeon, Sang Hoon Chun, Hyun Ae Jung, Hee Kyung Ahn, Kyung Hee Lee, Min-ho Kim, Ju Hee Kim, Jaekyung Cheon, Su-Jin Koh
    Supportive Care in Cancer.2022; 30(9): 7431.     CrossRef
  • A National Study of Life-Sustaining Treatments in South Korea: What Factors Affect Decision-Making?
    So-Youn Park, Bomyee Lee, Jeong Yeon Seon, In-Hwan Oh
    Cancer Research and Treatment.2021; 53(2): 593.     CrossRef
  • Difficulties Doctors Experience during Life-Sustaining Treatment Discussion after Enactment of the Life-Sustaining Treatment Decisions Act: A Cross-Sectional Study
    Shin Hye Yoo, Wonho Choi, Yejin Kim, Min Sun Kim, Hye Yoon Park, Bhumsuk Keam, Dae Seog Heo
    Cancer Research and Treatment.2021; 53(2): 584.     CrossRef
  • Changes in decision-making process for life-sustaining treatment in patients with advanced cancer after the life-sustaining treatment decisions-making act
    Hyeyeong Kim, Hyeon-Su Im, Kyong Og Lee, Young Joo Min, Jae-Cheol Jo, Yunsuk Choi, Yoo Jin Lee, Daseul Kang, Changyoung Kim, Su-Jin Koh, Jaekyung Cheon
    BMC Palliative Care.2021;[Epub]     CrossRef
  • Consent for withholding life-sustaining treatment in cancer patients: a retrospective comparative analysis before and after the enforcement of the Life Extension Medical Decision law
    Yu Jin Chung, Incheol Park, Junho Cho, Jin Ho Beom, Ji Eun Lee
    BMC Medical Ethics.2021;[Epub]     CrossRef
  • Implication of the Life-Sustaining Treatment Decisions Act on End-of-Life Care for Korean Terminal Patients
    Jung Sun Kim, Shin Hye Yoo, Wonho Choi, Yejin Kim, Jinui Hong, Min Sun Kim, Hye Yoon Park, Bhumsuk Keam, Dae Seog Heo
    Cancer Research and Treatment.2020; 52(3): 917.     CrossRef
  • 6,331 View
  • 176 Download
  • 13 Web of Science
  • 12 Crossref
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The Effect of Hospice Consultation on Aggressive Treatment of Lung Cancer
Shin Hye Yoo, Bhumsuk Keam, Miso Kim, Tae Min Kim, Dong-Wan Kim, Dae Seog Heo
Cancer Res Treat. 2018;50(3):720-728.   Published online July 14, 2017
DOI: https://doi.org/10.4143/crt.2017.169
AbstractAbstract PDFPubReaderePub
Purpose
The aims of this study were to investigate trends of aggressive treatment of non-small cell lung cancer (NSCLC) patients at the end-of-life (EOL) during the recent 5 years and examine the relationship between hospice consultation (HC) and aggressive care.
Materials and Methods
The medical records of 789 patients with stage IIIB-IV NSCLC at Seoul National University Hospital (SNUH) who received palliative chemotherapy and died from 2010 to 2014 were retrospectively reviewed. Indicators of aggressive treatment were evaluated, and the association of HC with these indicators was analyzed.
Results
During the last 5 years, the frequency of HC increased from 26.7% to 43.6%. The time interval from last chemotherapy to death increased, and the proportion of patients who received palliative chemotherapy, visited an emergency room, were admitted to intensive care unit, during the last month of life, and died in SNUH significantly decreased over time. Referral to HC was significantly associated with lower intensive care unit admission rates, lower out-of-hospital death rates, and less use of the chemotherapy within 1 month prior to death. Overall survival did not differ by HC.
Conclusion
The pattern of cancer care nearthe EOL has become less aggressivewhen HCwas provided. The positive association of HCwith better EOL care suggests that providing HC at the optimal time might help to avoid futile aggressive treatment.

Citations

Citations to this article as recorded by  
  • Hospice delivery models and survival differences in the terminally ill: a large cohort study
    Wei-Shu Lai, I-Ting Liu, Jui-Hung Tsai, Pei-Fang Su, Pin-Hsuan Chiu, Ying-Tzu Huang, Ge-Lin Chiu, Yu-Yeh Chen, Peng-Chan Lin
    BMJ Supportive & Palliative Care.2024; 14(e1): e1134.     CrossRef
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    Jeong-Han Kim, Shin Hye Yoo, Bhumsuk Keam, Dae Seog Heo
    Journal of Antimicrobial Chemotherapy.2023; 78(7): 1694.     CrossRef
  • Discussing POLST-facilitated hospice care enrollment in patients with terminal cancer
    Ho Jung An, Hyun Jeong Jeon, Sang Hoon Chun, Hyun Ae Jung, Hee Kyung Ahn, Kyung Hee Lee, Min-ho Kim, Ju Hee Kim, Jaekyung Cheon, Su-Jin Koh
    Supportive Care in Cancer.2022; 30(9): 7431.     CrossRef
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    Wenjing Cao, Chunyan Li, Qianqian Zhang, Huiru Tong
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    Elleana J. Majdinasab, Yana Puckett, Kevin Y. Pei
    Supportive Care in Cancer.2021; 29(6): 3201.     CrossRef
  • Changes of End of Life Practices for Cancer Patients and Their Association with Hospice Palliative Care Referral over 2009-2014: A Single Institution Study
    Hyun Jung Jho, Eun Jung Nam, Il Won Shin, Sun Young Kim
    Cancer Research and Treatment.2020; 52(2): 419.     CrossRef
  • Implication of the Life-Sustaining Treatment Decisions Act on End-of-Life Care for Korean Terminal Patients
    Jung Sun Kim, Shin Hye Yoo, Wonho Choi, Yejin Kim, Jinui Hong, Min Sun Kim, Hye Yoon Park, Bhumsuk Keam, Dae Seog Heo
    Cancer Research and Treatment.2020; 52(3): 917.     CrossRef
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    JinShil Kim, Jiin Choi, Mi-Seung Shin, Miyeong Kim, EunJu Seo, Minjeong An, Jae Lan Shim, Seongkum Heo, Hans-Peter Brunner-La Rocca
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    Roberta I. Jordan, Matthew J. Allsop, Yousuf ElMokhallalati, Catriona E. Jackson, Helen L. Edwards, Emma J. Chapman, Luc Deliens, Michael I. Bennett
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    Miyeong Kim, Seongkum Heo, Jung-Yi Hur, JaeLan Shim, JinShil Kim
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    Amanda J.W. Gibson, Haocheng Li, Adrijana D’Silva, Anifat A. Elegbede, Roxana A. Tudor, Shannon Otsuka, D. Gwyn Bebb, Winson Y. Cheung
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The Association between End-of-Life Care and the Time Interval between Provision of a Do-Not-Resuscitate Consent and Death in Cancer Patients in Korea
Sun Kyung Baek, Hye Jung Chang, Ja Min Byun, Jae Joon Han, Dae Seog Heo
Cancer Res Treat. 2017;49(2):502-508.   Published online September 1, 2016
DOI: https://doi.org/10.4143/crt.2016.073
AbstractAbstract PDFPubReaderePub
Purpose
We explored the relationship between the use of each medical intervention and the length of time between do-not-resuscitate (DNR) consent and death in Korea.
Materials and Methods
A total of 295 terminal cancer patients participated in this retrospective study. Invasive interventions (e.g., cardiopulmonary resuscitation, intubation, and hemodialysis), less invasive interventions (e.g., transfusion, antibiotic use, inotropic use, and laboratory tests), and the time interval between the DNR order and death were evaluated. The subjects were divided into three groups based on the amount of time between DNR consent and death (G1, time interval ≤ 1 day; G2, time interval > 1 day to ≤ 3 days; and G3, time interval > 3 days).
Results
In general, there were fewer transfusions and laboratory tests near death. Invasive interventions tended to be implemented only in the G1 group. There was also less inotrope use and fewerlaboratory tests in the G3 group than G1 and G2. Moreover, the G3 group received fewer less invasive interventions than those in G1 (odds ratio [OR], 0.16; 95% confidence interval [CI], 0.03 to 0.84; 3 days before death, and OR, 0.16; 95% CI, 0.04 to 0.59; the day before death). The frequency of less invasive interventions both 1 and 3 days before death was significantly lower for the G3 group than the G1 (p ≤ 0.001) and G2 group compared to G1 (p=0.001).
Conclusion
Earlier attainment of DNR permission was associated with reduced use of medical intervention. Thus, physicians should discuss death with terminal cancer patients at the earliest practical time to prevent unnecessary and uncomfortable procedures and reduce health care costs.

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Medical Costs and Healthcare Utilization among Cancer Decedents in the Last Year of Life in 2009
Inuk Hwang, Dong Wook Shin, Kyoung Hee Kang, Hyung Kook Yang, So Young Kim, Jong-Hyock Park
Cancer Res Treat. 2016;48(1):365-375.   Published online March 2, 2015
DOI: https://doi.org/10.4143/crt.2014.088
AbstractAbstract PDFPubReaderePub
Purpose
The purpose of this study was to evaluate the cancer care cost during the last year of life of patients in Korea. Materials and Methods We studied the breakdown of spending on the components of cancer care. Cancer decedents in 2009 were identified from the Korean Central Cancer Registry and linked with the Korean National Health Insurance Claims Database. The final number of patients included in the study was 70,558.
Results
In 2009, the average cancer care cost during the last year of life was US $15,720. Patients under age 20 spent US $53,890 while those 70 or over spent US $11,801. Those with leukemia incurred the highest costs (US $43,219) while bladder cancer patients spent the least (US $13,155). General costs, drugs other than analgesics, and test fees were relatively high (29.7%, 23.8%, and 20.7% of total medical costs, respectively). Analgesic drugs, rehabilitation, and psychotherapy were still relatively low (4.3%, 0.7%, and 0.1%, respectively). Among the results of multiple regression analysis, few were notable. Age was found to be negatively related to cancer care costs while income level was positively associated. Those classified under distant Surveillance, Epidemiology, and End Results stages of cancer and higher comorbidity level also incurred higher cancer care costs. Conclusion Average cancer care costs varied significantly by patient characteristics. However, the study results suggest an underutilization of support services likely due to lack of alternative accommodations for terminal cancer patients. Further examination of utilization patterns of healthcare resources will help provide tailored evidence for policymakers in efforts to reduce the burdens of cancer care.

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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
AbstractAbstract PDFPubReaderePub
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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