Cancer Research and Treatment

Original Articles

Exploring Oncologists’ Perspectives on the Early Integration of Specialty Palliative Care in Korea: Challenges, Needs, and Clinical Implications: Shin Hye Yoo, Yu Jung Kim, Ye Sul Jeung, Jung Sun Kim, Kwonoh Park, Eun Mi Nam, Si Won Lee, Jun Ho Ji, Jwa Hoon Kim, Joon Young Hur, Song Ee Park, Jung Lim Lee, Su-Jin Koh; Received February 11, 2025 Accepted April 9, 2025 Published online April 10, 2025; DOI: https://doi.org/10.4143/crt.2025.158 [Accepted]

Abstract PDF: Purpose
This study aimed to explore the practices, perceptions, and barriers related to specialty palliative care (SPC) referrals among oncologists in Korea, highlighting the clinical implications of early integration.
Materials and Methods
A cross-sectional online survey targeting board-certified hemato-oncology specialists was conducted between August 1–25, 2024. The survey assessed referral practices, attitudes toward early SPC integration, referral criteria, barriers, and institutional characteristics.
Results
A total of 227 oncologists participated (response rate: 36.7%). Among them, 68.7% reported frequent SPC referrals, with higher referral rates observed among younger physicians, those in tertiary hospitals, and institutions with in-house SPC teams (p<0.001). Although 74.9% supported early SPC integration, referrals were often inconsistently timed, frequently occurring after disease progression or at the discontinuation of chemotherapy. For time-based referrals, the most commonly endorsed triggers were disease progression despite palliative second-line treatment and a prognosis of expected mortality within 6–12 months. Need-based referral triggers such as patient or family requests (96.5%), psychological distress (89.9%), or uncontrolled symptoms (83.3%), were also widely endorsed. The major barriers to early SPC integration included patient and family resistance (70.0%) and limited availability of SPC teams (34.4%).
Conclusion
This study emphasizes the importance of systematic efforts to promote timely SPC integration in Korea, including education to raise patient awareness, improved referral systems, and enhanced infrastructure. The positive attitudes toward early SPC among oncologists reflect a growing recognition of its value, highlighting the need for strategies that align with international standards.

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Associations of Financial Toxicity with Employment Concerns and Cancer-Related Distress: A Cross-Sectional Survey among Korean Working-Age Cancer Survivors: Hyun-Ju Seo, Dal-Lae Jin, Young Ae Kim, Su Jung Lee, Seok-Jun Yoon; Received January 24, 2024 Accepted December 2, 2024 Published online December 3, 2024; DOI: https://doi.org/10.4143/crt.2024.090 [Epub ahead of print]

Abstract PDF Supplementary Material PubReader ePub

Purpose
Although South Korea’s health insurance has a co-payment-decreasing policy for cancer survivors, information on the extent of financial toxicity and its related factors is limited. We assessed the level of financial toxicity and the association of high levels of financial toxicity with employment concerns after diagnosis and cancer-related distress in working-age cancer survivors.
Materials and Methods
A cross-sectional study was conducted. Study participants were recruited from the National Cancer Survivorship Center between November and December 2022. Financial burden was assessed using the Korean version of the Comprehensive Score for Financial Toxicity, and cancer-related distress was measured using the National Comprehensive Cancer Network Distress Thermometer. Multivariate logistic regression analyses were used to explore the associations between high financial toxicity, cancer-related distress, and changes in employment status after cancer diagnosis.
Results
Of 1,403 working-age cancer survivors, approximately 62% reported high levels of financial distress. Survivors reporting early retirement and taking time off work with the intent to return were more likely to report high financial toxicity (adjusted odds ratio [OR], 1.69; 95% confidence interval [CI], 1.14 to 2.5; and adjusted OR, 2.82; 95% CI, 1.24 to 6.43, respectively) than those with a full-time or part-time job. Moreover, cancer survivors with high distress levels were more likely to report high financial toxicity than those with low distress levels (adjusted OR, 4.36; 95% CI, 3.17 to 5.99).
Conclusion
High financial toxicity is associated with adverse employment concerns and cancer-related distress among working-age cancer survivors. Therefore, developing cancer survivorship interventions within the healthcare system is necessary to ensure improvements in financial well-being.

Citations

Citations to this article as recorded by

Chronic Disease and Future Perceptions of Financial Control
Victoria H. Davis, Guanghao Zhang, Minal R. Patel
Medical Care.2025;[Epub] CrossRef

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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

Abstract PDF Supplementary Material PubReader ePub

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
Clinical characteristics and prognostic factors of sepsis in patients with malignancy
Green Hong, Hyekyeong Ju, Dong Kyu Oh, Su Yeon Lee, Mi Hyeon Park, Haein Lee, Chae-Man Lim, Song I Lee, Sang-Bum Hong, Gee Young Suh, Kyeongman Jeon, Ryoung-Eun Ko, Young-Jae Cho, Yeon Joo Lee, Sung Yoon Lim, Sunghoon Park, Jeongwon Heo, Jae-myeong Lee, K
Scientific Reports.2025;[Epub] 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

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Risky Lifestyle Behaviors among Gastric Cancer Survivors Compared with Matched Non-cancer Controls: Results from Baseline Result of Community Based Cohort Study: Minkyung Kim, Kui Son Choi, Mina Suh, Jae Kwan Jun, Kumban Walter Chuck, Boyoung Park; Cancer Res Treat. 2018;50(3):738-747. Published online July 24, 2017; DOI: https://doi.org/10.4143/crt.2017.129

Abstract PDF PubReader ePub

Purpose
This study investigated the prevalence of smoking, drinking, and physical inactivity and the associated factors of these behaviors in gastric cancer survivors.
Materials and Methods
The baseline data from the nationwide cohort study was used. Four hundred thirty-seven gastric cancer survivors who survived ≥ 2 years from diagnosis and reported completion of treatment were matched with 4,370 controls according to age, sex, education, and household income.
Results
The prevalence rates of current smoking and drinking among gastric cancer survivors were 8.7% and 38.3%, which were significantly lower than those among matched controls (p ≤ 0.001), but the prevalence rates of physical inactivity were not significantly different (55.8% vs. 59.9%, p=0.248). In gastric cancer survivors, ≥ 5 years since cancer diagnosis and current drinking contributed to more current smoking; otherwise, age increment and femalewere associatedwith lower current smoking. Thosewith household income ≥ $2,000 and current smokers were more likely to drink and female showed less drinking. Female, currently employed state, and self-rated health status were associated with more physical inactivity.
Conclusion
Although gastric cancer survivors showed better health behaviors than controls, suggesting that the diagnosis of cancer may motivate individuals towards healthy behaviors, their current prevalence rates of smoking and drinking were still high, and more than 50% of them were physically inactive. Tailored interventions to improve their health behaviors considering associated factors for the gastric cancer survivors are necessary.

Citations

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Gastric Cancer Survivorship: Multidisciplinary Management, Best Practices and Opportunities
Era Cobani, Mohammed Najeeb Al Hallak, Anthony F. Shields, Jordan Maier, Thomas E. Kelly, Niren Naidoo, Miguel Tobon, Steve Kim, Eliza W. Beal
Journal of Gastrointestinal Cancer.2024; 55(2): 519. CrossRef
Characterizing risky alcohol use, cigarette smoking, e-cigarette use, and physical inactivity among cancer survivors in the USA—a cross-sectional study
Jiyeong Kim, Theresa H. Keegan
Journal of Cancer Survivorship.2023; 17(6): 1799. CrossRef
Risk of Metabolic Syndrome and Fatty Liver Diseases in Gastric Cancer Survivors: A Propensity Score-Matched Analysis
Sang Jo Han, Su Jung Baik, Young Hoon Yoon, Jie Hyun Kim, Hye Sun Lee, Soyoung Jeon, Hyojin Park
The Korean Journal of Gastroenterology.2023; 81(4): 154. CrossRef
Factors related to Cancer Preventive Behavior among Patients with Early Gastric Cancer who Underwent Endoscopic Submucosal Dissection
Sunghye Choo, Sanghee Kim, Yong Chan Lee, Eunsung Kim
Asian Oncology Nursing.2023; 23(2): 47. CrossRef
MicroRNA-4316 inhibits gastric cancer proliferation and migration via directly targeting VEGF-A
Haithm Mousa, Menglang Yuan, Xinsheng Zhang, Xiaomeng Li, Abdullah Shopit, Marwan Almoiliqy, Mohammed Alshwmi, Aisha Al-Dherasi, Yue Xu, Yunfei Zuo
Cancer Cell International.2020;[Epub] CrossRef
Assessment of Diet Quality and Adherence to Dietary Guidelines in Gastrointestinal Cancer Survivors: A Cross-Sectional Study
Sara Moazzen, Francisco O. Cortés-Ibañez, Barbara L. van Leeuwen, Behrooz Z. Alizadeh, Geertruida H. de Bock
Nutrients.2020; 12(8): 2232. CrossRef
miR-300/FA2H affects gastric cancer cell proliferation and apoptosis
Bo Hong, Jie Li, Chunxiao Huang, Tao Huang, Mengpei Zhang, Lijiang Huang
Open Medicine.2020; 15(1): 882. CrossRef
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Kyoungsik Jeong, Hoseok Kim, Siwoo Lee, Younghwa Baek
Journal of Physiology & Pathology in Korean Medicine.2020; 34(1): 53. CrossRef
Factors Associated with Health Behaviors in Thyroid Cancer Survivors
Junghyun Yoon, Boyoung Park
Journal of Cancer Prevention.2020; 25(3): 173. CrossRef
Discovery of potential therapeutic targets for non-small cell lung cancer using high-throughput metabolomics analysis based on liquid chromatography coupled with tandem mass spectrometry
Hong-dan Xu, Wen Luo, Yuanlong Lin, Jiawen Zhang, Lijuan Zhang, Wei Zhang, Shu-ming Huang
RSC Advances.2019; 9(19): 10905. CrossRef
Compliance with Multiple Health Behaviour Recommendations: A Cross-Sectional Comparison between Female Cancer Survivors and Those with no Cancer History
Daniel N Tollosa, Meredith Tavener, Alexis Hure, Erica L James
International Journal of Environmental Research and Public Health.2019; 16(8): 1345. CrossRef
El consumo de alcohol en los supervivientes al cáncer: estado de la cuestión y propuestas para el desarrollo de intervenciones psicológicas
Francisco García-Torres, Francisco J. Alós, Rosario Castillo-Mayén
Psicooncología.1970; 15(1): 65. CrossRef

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