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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
  • 6,332 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
  • Use of high‐flow nasal cannula oxygen therapy for patients with terminal cancer at the end of life
    Jung Sun Kim, Jeongmi Shin, Nam Hee Kim, Sun Young Lee, Shin Hye Yoo, Bhumsuk Keam, Dae Seog Heo
    Cancer Medicine.2023; 12(13): 14612.     CrossRef
  • Antibiotic prescription patterns during last days of hospitalized patients with advanced cancer: the role of palliative care consultation
    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
  • Perceptions on the current content and pedagogical approaches used in end-of-life care education among undergraduate nursing students: a qualitative, descriptive study
    Wenjing Cao, Chunyan Li, Qianqian Zhang, Huiru Tong
    BMC Medical Education.2022;[Epub]     CrossRef
  • Increased in-hospital mortality and emergent cases in patients with stage IV cancer
    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
  • Do advance directive attitudes and perceived susceptibility and end-of-life life-sustaining treatment preferences between patients with heart failure and cancer differ?
    JinShil Kim, Jiin Choi, Mi-Seung Shin, Miyeong Kim, EunJu Seo, Minjeong An, Jae Lan Shim, Seongkum Heo, Hans-Peter Brunner-La Rocca
    PLOS ONE.2020; 15(9): e0238567.     CrossRef
  • Duration of palliative care before death in international routine practice: a systematic review and meta-analysis
    Roberta I. Jordan, Matthew J. Allsop, Yousuf ElMokhallalati, Catriona E. Jackson, Helen L. Edwards, Emma J. Chapman, Luc Deliens, Michael I. Bennett
    BMC Medicine.2020;[Epub]     CrossRef
  • Relationship Between Preferences for Advance Directive Treatments and Decisional Conflicts Among Low-Income, Home-Based Cancer Management Recipients in Korea
    Miyeong Kim, Seongkum Heo, Jung-Yi Hur, JaeLan Shim, JinShil Kim
    Journal of Transcultural Nursing.2019; 30(6): 587.     CrossRef
  • Factors associated with early mortality in non-small cell lung cancer patients following systemic anti-cancer therapy: A 10 year population-based study
    Amanda J.W. Gibson, Haocheng Li, Adrijana D’Silva, Anifat A. Elegbede, Roxana A. Tudor, Shannon Otsuka, D. Gwyn Bebb, Winson Y. Cheung
    Lung Cancer.2019; 134: 141.     CrossRef
  • Interventions to reduce aggressive care at end of life among patients with cancer: a systematic review
    Nauzley C Abedini, Rachel K Hechtman, Achintya D Singh, Rafina Khateeb, Jason Mann, Whitney Townsend, Vineet Chopra
    The Lancet Oncology.2019; 20(11): e627.     CrossRef
  • Demographic and Socioeconomic Factors for Renouncing Further Active Therapy for Patients with Brain Metastasis of Non-Small Cell Lung Cancer
    Gyuseo Jung, Seok-Hyun Kim, Tae Gyu Kim, Young Zoon Kim
    Brain Tumor Research and Treatment.2019; 7(2): 112.     CrossRef
  • 9,688 View
  • 261 Download
  • 16 Web of Science
  • 14 Crossref
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Trends in the Aggressiveness of End-of-Life Care for Advanced Stomach Cancer Patients
Ji Hyung Hong, Sang-Young Rho, Young Seon Hong
Cancer Res Treat. 2013;45(4):270-275.   Published online December 31, 2013
DOI: https://doi.org/10.4143/crt.2013.45.4.270
AbstractAbstract PDFPubReaderePub
PURPOSE
It is important to balance the appropriateness of active cancer treatments and end-of-life care to improve the quality of life for terminally ill cancer patients. This study describes the treatment patterns and end-of-life care in terminal gastric cancer patients.
MATERIALS AND METHODS
We retrospectively analyzed the records of 137 patients with advanced gastric cancer receiving chemotherapy and dying between June 1, 2006 and May 31, 2011. We recorded interval between last chemotherapy dose and death; frequency of emergency room visits or admission to the intensive care unit in the last month before death; rate of hospice referral and agreement with written do-not-resuscitate orders; and change in laboratory values in the last three months before death.
RESULTS
During the last six months of life, 130 patients (94.9%) received palliative chemotherapy; 86 (62.7%) during the final two months; 41 (29.9%) during the final month. During the final month, 53 patients (38.7%) visited an emergency room more than once; 21 (15.3%) were admitted to the intensive care unit. Hospice referral occurred in 54% (74 patients) of the patients; 93.4% (128 patients) gave written do-not-resuscitate orders. Platelets, aspartate aminotransferase and creatinine changed significantly two weeks before death; total bilirubin, one month before; and C-reactive protein, between four and two weeks before death.
CONCLUSION
Our results demonstrated that a significant proportion of gastric cancer patients received palliative chemotherapy to the end of life and the patients who stopped the chemotherapy at least one month before death had a lower rate of intensive care unit admission and longer overall survival than those who sustained aggressive chemotherapy until the last months of their lives.

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
  • Automated machine learning (AutoML) can predict 90-day mortality after gastrectomy for cancer
    Gopika SenthilKumar, Sharadhi Madhusudhana, Madelyn Flitcroft, Salma Sheriff, Samih Thalji, Jennifer Merrill, Callisia N. Clarke, Ugwuji N. Maduekwe, Susan Tsai, Kathleen K. Christians, T. Clark Gamblin, Anai N. Kothari
    Scientific Reports.2023;[Epub]     CrossRef
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    Chetna Malhotra, Filipinas Bundoc, Isha Chaudhry, Irene Teo, Semra Ozdemir, Eric Finkelstein, Rebecca A. Dent, Nesaretnam Barr Kumarakulasinghe, Yin Bun Cheung, Rahul Malhotra, Ravindran Kanesvaran, Alethea Chung Pheng Yee, Noreen Chan, Huei Yaw Wu, Soh M
    BMC Palliative Care.2022;[Epub]     CrossRef
  • Quality of End-of-Life Care in Gastrointestinal Cancers: A 13-Year Population-Based Retrospective Analysis in Ontario, Canada
    Caitlin SR Lees, Hsien Seow, Kelvin KW Chan, Anastasia Gayowsky, Aynharan Sinnarajah
    Current Oncology.2022; 29(12): 9163.     CrossRef
  • Use of Palliative Chemotherapy and ICU Admissions in Gastric and Esophageal Cancer Patients in the Last Phase of Life: A Nationwide Observational Study
    Joost Besseling, Jan Reitsma, Judith A. Van Erkelens, Maike H. J. Schepens, Michiel P. C. Siroen, Cathelijne M. P. Ziedses des Plantes, Mark I. van Berge Henegouwen, Laurens V. Beerepoot, Theo Van Voorthuizen, Lia Van Zuylen, Rob H. A. Verhoeven, Hanneke
    Cancers.2021; 13(1): 145.     CrossRef
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    M. Santero, J. Pérez-Bracchiglione, R. Acosta-Dighero, A. G. Meade, A. Antequera, A. Auladell-Rispau, M. J. Quintana, C. Requeijo, G. Rodríguez-Grijalva, K. Salas-Gama, R. Dorantes-Romandia, J. Salazar, I. Solà, G. Urrútia, X. Bonfill Cosp
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    Karin Dalhammar, Marlene Malmström, Magnus Sandberg, Dan Falkenback, Jimmie Kristensson
    BMC Health Services Research.2021;[Epub]     CrossRef
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    Paul R. Duberstein, Michael Chen, Michael Hoerger, Ronald M. Epstein, Laura M. Perry, Sule Yilmaz, Fahad Saeed, Supriya G. Mohile, Sally A. Norton
    Journal of Pain and Symptom Management.2020; 59(4): 894.     CrossRef
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    PLOS ONE.2020; 15(6): e0235045.     CrossRef
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    Journal of Hematology & Oncology.2018;[Epub]     CrossRef
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  • Adopting Advance Directives Reinforces Patient Participation in End-of-Life Care Discussion
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  • Cases and Literature Review of Timing for Withdrawal of Palliative Chemotherapy
    Yun Jin Jeong, Do Yeun Kim
    The Korean Journal of Hospice and Palliative Care.2016; 19(1): 70.     CrossRef
  • End-of-life care for hospitalized patients with metastatic melanoma in France: a nationwide, register-based study
    I. Gallais Sérézal, Y. Beaussant, P. Rochigneux, C. Tournigand, R. Aubry, B. Lindelöf, L. Morin
    British Journal of Dermatology.2016; 175(3): 583.     CrossRef
  • Trends in the Aggressiveness of End-of-Life Cancer Care in the State of Qatar
    Azza A. Hassan, Hassan Mohsen, Ayman A. Allam, Pascale Haddad
    Journal of Global Oncology.2016; 2(2): 68.     CrossRef
  • Investigational tests and treatments performed in terminal stage cancer patients in two weeks before death: Turkish oncology group (TOG) study
    İbrahim Türker, Şeref Kömürcü, Ali Arıcan, Hatice Doruk, Özgür Özyılkan, Hasan Şenol Coşkun, Dilşen Çolak, Emel Üçgül Çavuşoğlu, Alper Ata, Ahmet Sezer, Havva Yeşil Çınkır, Filiz Çay Şenler, Fikret Arpacı
    Medical Oncology.2014;[Epub]     CrossRef
  • 11,884 View
  • 82 Download
  • 21 Crossref
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