Cancer Research and Treatment

Original Articles

Gaps between Supportive Care Needs and Services in Korea: Experiences and Preferences of Patients with Advanced Cancer and Their Caregivers in the Hospital and at Home: Min Seol Jang, In Gyu Hwang, Shin Hye Yoo, Belong Cho, Bhumsuk Keam, Yu Jung Kim, Sun Kyung Baek, Min Sun Kim, Sun Young Lee; Received October 23, 2025 Accepted May 4, 2026 Published online May 7, 2026; DOI: https://doi.org/10.4143/crt.2025.1162 [Accepted]

Abstract PDF: Purpose
With longer survivals in advanced cancer, the need for supportive care is increasing. However, in Korea, these services remain limited, and many patients rely on long-term care hospitals. We investigated the supportive care experiences of patients with advanced cancer and their caregivers, and preferred place of care (pPOC) by performance status (PS).
Materials and Methods
A cross-sectional survey was conducted at a tertiary hospital in Seoul, Korea, targeting patients hospitalized only for supportive care and their caregivers. PS was assessed using the Eastern Cooperative Oncology Group scale [good (0–1) or poor (2–4)]. Hospital and home care experiences and pPOC were compared by PS. Logistic regression analysis was used to identify factors associated with pPOC.
Results
This study included 200 participants (117 patients, 83 caregivers). Among patients, 72% had good PS and 28% had poor PS. Main reasons for hospitalization were symptom control (51.2%), assistance with daily living (36.5%), and device or wound management (22.5%). Overall, 60.5% of participants reported discomfort during hospitalization, mostly related to hospital life, and 34.5% noted that care was insufficient at home, particularly those in the poor PS group (27.1% vs. 53.6%). Concern about emergencies was the most common home-care difficulty. Despite these challenges, 60% of participants chose home as their future pPOC, with no significant differences by PS or other demographic/clinical factors.
Conclusion
Although most patients with advanced cancer and their caregivers preferred home for supportive care, many relied on hospitals. Structured home-based medical care programs are urgently required in South Korea.

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Impact of Pre-admission Central Nervous System Medication Use on Delirium in Hospitalized Patients with Advanced Cancer: A Multicenter, Prospective, Observational Study in Korea: Min Jung Geum, Shin Hye Yoo, Si Won Lee, Moonki Hong, Eun Hee Jung, Yu Jung Kim, Beodeul Kang; Received April 29, 2025 Accepted August 26, 2025 Published online August 27, 2025; DOI: https://doi.org/10.4143/crt.2025.460 [Epub ahead of print]

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Purpose
This study investigated the impact of pre-admission central nervous system (CNS) medication use on delirium incidence, duration, and survival in hospitalized patients with advanced cancer.
Materials and Methods
In this multicenter prospective study across four tertiary hospitals in South Korea, adults with advanced cancer were enrolled and categorized based on their use of CNS medications within 90 days preceding admission. Associations between pre-admission CNS medication use and outcomes (delirium incidence, delirium duration, and overall survival) were assessed using multivariable regression and Cox proportional hazards models.
Results
Of the 190 patients enrolled, 140 had used CNS medications prior to admission. Delirium occurred in 22.1% of the patients with CNS medication use versus 14.0% of those without (adjusted odds ratio [aOR], 2.53; 95% confidence interval [CI], 0.95 to 7.60; not significant). Opioid (aOR, 2.48; 95% CI, 1.01 to 6.61) and antidepressant (aOR, 5.58; 95% CI, 1.22 to 27.35) use were significantly associated with increased delirium risk. Use of three or more CNS medication classes was associated with a markedly high risk (aOR, 11.15; 95% CI, 2.13 to 64.17). Delirium duration did not differ significantly between groups. Patients with pre-admission CNS medication exposure exhibited shorter overall survival (adjusted hazard ratio [aHR], 1.45; 95% CI, 1.01 to 2.09). Prior opioid use was also associated with increased mortality (aHR, 1.45; 95% CI, 1.03 to 2.05).
Conclusion
Pre-admission exposure to CNS medication, particularly opioids and antidepressants, was associated with an increased risk of delirium in patients with advanced cancer. A thorough medication history review upon admission is crucial to identifying high-risk patients and implementing early preventive interventions.

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Prevalence of delirium among patients with advanced cancer: a systematic review and meta-analysis
Linshan Jiang, Zhongyin Zhang, Xiaojun Liu, Yanxing Jiang, Qianqian Mou
Frontiers in Neurology.2026;[Epub] CrossRef

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Palliative medicine

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; Cancer Res Treat. 2026;58(1):339-348. Published online April 10, 2025; DOI: https://doi.org/10.4143/crt.2025.158

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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.

Citations

Citations to this article as recorded by

Intensivists’ Perspectives and Practices on Palliative Care in the ICU: A Nationwide Survey in Korea
Tae Jung Kim, Yoon Sun Jung, Ye Sul Jeung, Woo Hyun Cho, Shin Hye Yoo, Jae Young Moon
Journal of Korean Medical Science.2026;[Epub] CrossRef
Improving Quality of End-of-Life Care Through the K-HOPE Consultative Palliative Care Model: A Prospective Study in a Tertiary Hospital
Yoo Jeong Lee, In Cheol Hwang, Eun Jeong Lee, Soon-Young Hwang, Youn Seon Choi
Current Oncology.2026; 33(4): 213. CrossRef
Association between the timing of palliative care consultation and end-of-life outcomes in patients with cancer
Jung Sun Kim, Wan Taek Lee, Bhumsuk Keam, Jin-Ah Sim, Shin Hye Yoo
Supportive Care in Cancer.2026;[Epub] CrossRef

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Psychometric Validation of Sheffield Profile for Assessment and Referral to Care (SPARC) in Korean Cancer Patients: Hong Jun Kim, Eun Hee Jung, Jung Hye Kwon, Yu Jung Kim, Su-Jin Koh, Myung Ah Lee, Jung Hun Kang, Sun Young Rha, Eun Mi Nam, Sun Kyung Baek, Ha Yeon Lee, Hun Ho Song, Young-Woong Won, Hanbyul Lee; Cancer Res Treat. 2025;57(3):891-898. Published online December 5, 2024; DOI: https://doi.org/10.4143/crt.2024.706

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Purpose
Identifying the palliative care needs of patients with advanced cancer is important for maintaining quality of life and timely transition to palliative care. We aimed to validate the Korean Sheffield Profile for Assessment and Referral for Care (K-SPARC) in such patients and establish its psychometric properties, including reliability, validity, and responsiveness to change.
Materials and Methods
We used the forward-back translated version of SPARC, which was verified through a pilot study, to assess the palliative care needs of patients with advanced cancer. Reliability was evaluated by internal consistency using Cronbach's alpha coefficients and test-retest reliability. Criterion validity was analyzed against other questionnaires, including the Korean versions of the Functional Assessment of Cancer Therapy-General (FACT-G Korean) and Korean versions of the Edmonton Symptom Assessment System (K-ESAS). Factor analysis was used to assess construct validity.
Results
Two hundred fifty-nine patients were included from 2019 to 2022. Forty-nine percent of all patients were women, and the median age was 63 years. Cronbach’s alpha coefficient (range, 0.642 to 0.903) and test-retest reliability (range, 0.574 to 0.749) indicated acceptable reliability. The correlation coefficients between K-SPARC and FACT-G Korean suggested significant criterion validity. The correlation coefficients for the physical, social, emotional, and functional domains were 0.701, 0.249, 0.718, and 0.511, respectively (p < 0.001, all). Factor analysis demonstrated satisfactory construct validity of the tool.
Conclusion
This study demonstrated the utility of K-SPARC as an evaluation tool for providing palliative care to patients with advanced cancer through psychometric validation; the tool had good internal consistency, reliability, and acceptable validity.

Citations

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Design, adaptation and content validation of the Sheffield Profile for Assessment and Referral for Care in Colombian Spanish (SPARC-Sp-Col)
Cindy V. Mendieta, Esther de Vries, Jose A. Calvache, Sam H. Ahmedzai, Gillian Prue, Joanne Reid
BMC Palliative Care.2026;[Epub] CrossRef
Cross-cultural adaptation and preliminary psychometric evaluation of the Chinese version of the Self-Blame Attribution for Cancer Scale in patients with gynecologic cancer
Dahang Li, Yishu Zhang, Xinyu Shen, Xin Zhao
European Journal of Oncology Nursing.2026; 84: 103293. CrossRef
Holistic needs assessment for hospitalized patients with breast cancer: A prospective cross-sectional study
Shin-Ling Wen, Shu-Fen Chen, Chien-Ling Su, Hsueh-Chi Wu, Yun-Yun Chou, Tzu-Tung Kuo, Li-Sin Hsiao, Ka-Wai Tam
Applied Nursing Research.2026; 91: 152134. CrossRef

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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 Res Treat. 2025;57(1):280-288. Published online July 1, 2024; DOI: https://doi.org/10.4143/crt.2024.360

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Purpose
In Korea, the Act on Hospice and Palliative Care and Decisions on Life-Sustaining Treatment (LST) was implemented on February 4, 2018. We aimed to investigate relevant factors and clinical changes associated with LST decisions after law enforcement.
Materials and Methods
This single-center retrospective study included patients who completed LST documents using legal forms at Asan Medical Center from February 5, 2018, to June 30, 2020.
Results
5,896 patients completed LST documents, of which 2,704 (45.8%) signed the documents in person, while family members of 3,192 (54%) wrote the documents on behalf of the patients. Comparing first year and following year of implementation of the act, the self-documentation rate increased (43.9% to 47.2%, p=0.014). Moreover, the number of LST decisions made during or after intensive care unit admission decreased (37.8% vs. 35.2%, p=0.045), and the completion rate of LST documents during chemotherapy increased (6.6% vs. 8.9%, p=0.001). In multivariate analysis, age < 65 (odds ratio [OR], 1.724; 95% confidence interval [CI], 1.538 to 1.933; p < 0.001), unmarried status (OR, 1.309; 95% CI, 1.097 to 1.561; p=0.003), palliative care consultation (OR, 1.538; 95% CI, 1.340 to 1.765; p < 0.001), malignancy (OR, 1.864; 95% CI, 1.628 to 2.133; p < 0.001), and changes in timing on the first year versus following year (OR, 1.124; 95% CI, 1.003 to 1.260; p=0.045) were related to a higher self-documentation rate.
Conclusion
Age < 65 years, unmarried status, malignancy, and referral to a palliative care team were associated with patients making LST decisions themselves. Furthermore, the subject and timing of LST decisions have changed with the LST act.

Citations

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Impact of Intensivist Authority on End-of-Life Practices in a Korean PICU
Yeonhee Lee, Kyeong Hun Lee, Boyeon Gu, Dagam Kim, In Kyung Lee
Clinical Pediatrics.2026; 65(4): 516. CrossRef
Awareness, attitudes, and educational needs regarding the life-sustaining treatment decision-making act in Korea among healthcare providers and medical students: a comparative analysis
Jooseon Lee, So-yun Kim, Duk-ki Kim, Green Hong, Song I Lee
BMC Medical Ethics.2026;[Epub] CrossRef
Impact of the Life-Sustaining Treatment Decision Act on the Incidence and Outcomes of In-Hospital Cardiopulmonary Resuscitation
Tak Kyu Oh, In-Ae Song
Critical Care Medicine.2026; 54(7): 1691. CrossRef
When advance directives clash with family consent: designing an operational framework for end-of-life decision-making in China and Korea
Songwu Luo, Dongje Cho, Jaehyun Cho
BMC Medical Ethics.2026;[Epub] CrossRef
Association between the timing of palliative care consultation and end-of-life outcomes in patients with cancer
Jung Sun Kim, Wan Taek Lee, Bhumsuk Keam, Jin-Ah Sim, Shin Hye Yoo
Supportive Care in Cancer.2026;[Epub] CrossRef

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5 Web of Science
5 Crossref

Development of a Prediction Model for Delirium in Hospitalized Patients with Advanced Cancer: Eun Hee Jung, Shin Hye Yoo, Si Won Lee, Beodeul Kang, Yu Jung Kim; Cancer Res Treat. 2024;56(4):1277-1287. Published online February 26, 2024; DOI: https://doi.org/10.4143/crt.2023.1243

Abstract PDF Supplementary Material PubReader ePub

Purpose
Delirium is a common neurocognitive disorder in patients with advanced cancer and is associated with poor clinical outcomes. As a potentially reversible phenomenon, early recognition of delirium by identifying the risk factors demands attention. We aimed to develop a model to predict the occurrence of delirium in hospitalized patients with advanced cancer.
Materials and Methods
This retrospective study included patients with advanced cancer admitted to the oncology ward of four tertiary cancer centers in Korea for supportive cares and excluded those discharged due to death. The primary endpoint was occurrence of delirium. Sociodemographic characteristics, clinical characteristics, laboratory findings, and concomitant medication were investigated for associating variables. The predictive model developed using multivariate logistic regression was internally validated by bootstrapping.
Results
From January 2019 to December 2020, 2,152 patients were enrolled. The median age of patients was 64 years, and 58.4% were male. A total of 127 patients (5.9%) developed delirium during hospitalization. In multivariate logistic regression, age, body mass index, hearing impairment, previous delirium history, length of hospitalization, chemotherapy during hospitalization, blood urea nitrogen and calcium levels, and concomitant antidepressant use were significantly associated with the occurrence of delirium. The predictive model combining all four categorized variables showed the best performance among the developed models (area under the curve 0.831, sensitivity 80.3%, and specificity 72.0%). The calibration plot showed optimal agreement between predicted and actual probabilities through internal validation of the final model.
Conclusion
We proposed a successful predictive model for the risk of delirium in hospitalized patients with advanced cancer.

Citations

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Prevalence and incidence of delirium in patients with cancer: An updated systematic review and meta-analysis
Joy-Lynn Goh, Jiani Zhu, Yingchun Zeng
European Journal of Oncology Nursing.2026; 83: 103220. CrossRef
Association Between Blood Urea Nitrogen and Delirium in Critically Ill Elderly Patients Without Kidney Diseases: A Retrospective Study and Mendelian Randomization Analysis
Yipeng Fang, Xiaohong Tang, Ying Gao, Hui Xie, Yuehao Shen, Min Peng, Jie Liu, Yunfei Zhang, Yan Cui, Keliang Xie
CNS Neuroscience & Therapeutics.2025;[Epub] CrossRef

4,717 View
144 Download
2 Web of Science
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Special Articles

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

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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.

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Advances in End-of-Life Care in Canada: Implications for Oncology Nursing
Reanne Booker, Stephanie Lelond, Kalli Stilos
Current Oncology.2026; 33(1): 38. CrossRef
Agitation and delirium in the last days of life: terminology and management—systematic review and narrative synthesis
Rebecca A Hatton, Gilli Erez, Miriam J Johnson
BMJ Supportive & Palliative Care.2026; : spcare-2025-005872. CrossRef
Nursing Practice for Patients with Cancer Pain with Predicted Prognosis of Months or Weeks: A Multicenter Cross-Sectional Study in Japan
Miharu Morikawa, Masamitsu Kobayashi, Kohei Kajiwara, Kimiko Nakano, Yusuke Kanno, Yoshinobu Matsuda, Jun Kako
Palliative Medicine Reports.2025;[Epub] CrossRef
Prognostic factors and nomogram-based survival prediction for patients with terminal-stage cancer: A retrospective study
Weiwei Gui, Chunhui Ding, Lei Xu, Yizhou Luo, Lingxiang Liu
Medicine.2025; 104(42): e45262. CrossRef
A qualitative study on the symptom experience and self-management strategies of patients undergoing chemotherapy and radiotherapy for esophageal cancer
Jing Chen, Xiuqin Ren
Gastrointestinal Tumors.2025;[Epub] CrossRef
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

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7 Web of Science
6 Crossref

Psychological Aspects of Care in Cancer Patients in the Last Weeks/Days of Life: Sujin Ann-Yi, Eduardo Bruera; Cancer Res Treat. 2022;54(3):651-660. Published online June 28, 2022; DOI: https://doi.org/10.4143/crt.2022.116

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Palliative care is comprised of an interdisciplinary team (IDT) approach with members from different disciplines who collaboratively work together to reduce multidimensional components of pain and suffering and improve quality of life for patients coping with a terminal illness. Psychosocial team members are integral to the palliative care IDT and provide expertise in assessment and empirically validated interventions to address psychological distress. The following paper will provide a review of different facets of psychological distress experienced by advanced cancer patients such as psychological disorders, existential distress, spiritual distress, caregiver distress, parental distress, and grief. Finally, an overview of commonly used screening and assessment tools as well as psychological interventions relevant for the palliative care population is presented.

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Palliative Sedation in End-of-Life Patients in Eastern Asia: A Narrative Review: Seung Hun Lee, Jung Hye Kwon, Young-Woong Won, Jung Hun Kang; Cancer Res Treat. 2022;54(3):644-650. Published online April 19, 2022; DOI: https://doi.org/10.4143/crt.2022.187

Abstract PDF PubReader ePub

Although palliative sedation (PS) is a common practice in the palliative care of cancer patients in Western countries, there is little related research on the practice in Korea. PS can be classified into several categories according to sedation level and continuity. PS is clearly distinct from euthanasia. While euthanasia is illegal and regarded as unethical in Korea, there is little ethical and legal controversy about PS in terms of the doctrine of double effect. Most studies have asserted that PS does not shorten the survival of terminal cancer patients. Since preference for PS heavily depends on stakeholder value, it should be preceded by shared decision-making through full communication among the patient, family members, and medical team. This is a narrative review article analyzing previous studies, especially from the three Eastern Asian countries, Korea, Japan and Taiwan, which share similar cultures compared with Western countries. Practical issues concerning PS—for example, prevalence, type and dosage of medications, salvage medication, timing of its initiation, and assessment—are described in detail.

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Jacqueline Wallage, Miriam L. Haaksma, Teun van Gelder, Wilco P. Achterberg, Maartje S. Klapwijk
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Original Article

Palliative medicine

A Prognostic Model to Facilitate Palliative Care Referral in Oncology Outpatients: Yu Jung Kim, Yusuke Hiratsuka, Sang-Yeon Suh, Beodeul Kang, Si Won Lee, Hong-Yup Ahn, Koung Jin Suh, Ji-Won Kim, Se Hyun Kim, Jin Won Kim, Keun-Wook Lee, Jee Hyun Kim, Jong Seok Lee; Cancer Res Treat. 2022;54(2):621-629. Published online July 12, 2021; DOI: https://doi.org/10.4143/crt.2021.483

Abstract PDF PubReader ePub

Purpose
We aimed to develop a prognostic model to assist palliative care referral at least 3 months before death in advanced cancer patients treated at an outpatient medical oncology clinic.
Materials and Methods
In this prospective cohort study, a total of 200 patients were enrolled at a tertiary cancer center in South Korea. The major eligibility criterion was an expected survival of less than a year as estimated by their oncologists. We analyzed the influences of known prognostic factors along with chemotherapy status, mid-arm circumference, and triceps skinfold thickness on survival time.
Results
The mean age of the patients was 64.5 years, 36% were female, and the median survival time was 7.6 months. In the multivariate analysis, we found 6 significant factors related to poor survival: a poor Eastern Cooperative Oncology Group (ECOG) performance status (≥2), not undergoing chemotherapy, anorexia, a low lymphocyte level (<12%), a high lactate dehydrogenase (LDH) level (≥300 IU/L), and a low mid-arm circumference (<23 cm). We developed a prognostic model (score, 0-8.0) to predict 3-month survival based on the multivariate analysis. Patients who scored ≥4.0 points had a short survival of less than 3 months (p<0.001). The discriminating ability of the prognostic model using the area under the receiver operating characteristic curve (AUC) was 0.88.
Conclusion
The prognostic model using ECOG performance status, chemotherapy status, anorexia, lymphocytes, LDH, and mid-arm circumference can predict 3-month survival in medical oncology outpatients. It can alert oncologists to refer patients to palliative care specialists before it is too late.

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Susanny J. Beltran, Lainey Dorris, Marie Hamel, Shanelle Harvey, Mustafa Ozkaynak, Kenan Sualp
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Yusuke Hiratsuka, Jun Hamano, Masanori Mori, Sang-Yeon Suh, David Hui
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Clinicians’ Prediction of Survival Is Most Useful for Palliative Care Referral
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Palliative Medicine Reports.2024;[Epub] CrossRef

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Special Article

Current Status and Cardinal Features of Patient Autonomy after Enactment of the Life-Sustaining Treatment Decisions Act in Korea: Hwa Jung Kim, Yu Jung Kim, Jung Hye Kwon, Young-Woong Won, Ha Yeon Lee, Sun Kyung Baek, Hyewon Ryu, Do Yeun Kim; Cancer Res Treat. 2021;53(4):917-925. Published online June 2, 2021; DOI: https://doi.org/10.4143/crt.2021.324

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Purpose
The main purpose of the Life-Sustaining Treatment Decisions Act recently enacted in Korea is to respect the patient’s self-determination. We aimed to investigate the current status and features of patient self-determination after implementation of the law.
Materials and Methods
Between February 2018 and January 2019, 54,635 cancer deaths were identified from the National Health Insurance Service (NHIS) database. We analyzed the characteristics of decedents who complied with the law process by self-determination compared with decedents with family determination and with decedents who did not comply with the law process.
Results
In multivariable analysis, patients with self-determination were younger, were less likely to live in rural areas, were less likely to belong to the highest income quintile, were less likely to be treated in general hospitals, and were more likely to show a longer time from cancer diagnosis compared with patients with family determination. Compared with patients who did not comply with the law process, patients with self-determination were younger, lived in Seoul or capital area, were less likely to belong to the highest income quintile, were treated in general hospitals, were less likely to have genitourinary or hematologic malignancies, scored higher on the Charlson comorbidity index, and showed a longer time from cancer diagnosis. Patients with self-determination were more likely to use hospice and less likely to use intensive care units (ICUs) at the end-of-life (EOL).
Conclusion
Decedents with self-determination were more likely to be younger, reside in the Seoul or capital area, show a longer time from cancer diagnosis, and were less likely to belong to the highest income quintile. They utilized hospice more frequently, and received less ICU care at the EOL.

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Original Articles

Palliative Medicine

Safety, Efficacy, and Patient Satisfaction with Initial Peripherally Inserted Central Catheters Compared with Usual Intravenous Access in Terminally Ill Cancer Patients: A Randomized Phase II Study: Eun Ju Park, Kwonoh Park, Jae-Joon Kim, Sang-Bo Oh, Ki Sun Jung, So Yeon Oh, Yun Jeong Hong, Jin Hyeok Kim, Joo Yeon Jang, Ung-Bae Jeon; Cancer Res Treat. 2021;53(3):881-888. Published online December 22, 2020; DOI: https://doi.org/10.4143/crt.2020.1008

Abstract PDF PubReader ePub

Purpose
The purpose of this study was to investigate whether routine insertion of peripherally inserted central catheter (PICC) at admission to a hospice-palliative care (HPC) unit is acceptable in terms of safety and efficacy and whether it results in superior patient satisfaction compared to usual intravenous (IV) access.
Materials and Methods
Terminally ill cancer patients were randomly assigned to two arms: routine PICC access and usual IV access arm. The primary endpoint was IV maintenance success rate, defined as the rate of functional IV maintenance until the intended time (discharge, transfer, or death).
Results
A total of 66 terminally ill cancer patients were enrolled and randomized to study arms. Among them, 57 patients (routine PICC, 29; usual IV, 28) were analyzed. In the routine PICC arm, mean time to PICC was 0.84 days (range, 0 to 3 days), 27 patients maintained PICC with function until the intended time. In the usual IV arm, 11 patients maintained peripheral IV access until the intended time, and 15 patients underwent PICC insertion. The IV maintenance success rate in the routine PICC arm (27/29, 93.1%) was similar to that in the usual IV arm (26/28, 92.8%, p=0.958). Patient satisfaction at day 5 was better in the routine PICC arm (97%, ‘a little comfort’ or ‘much comfort’) compared with the usual IV arm (21%) (p <0.001).
Conclusion
Routine PICC insertion in terminally ill cancer patients was comparable in safety and efficacy and resulted in superior satisfaction compared with usual IV access. Thus, routine PICC insertion could be considered at admission to the HPC unit.

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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.

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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”
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General

Pilot study for the Psychometric Validation of the Sheffield Profile for Assessment and Referral to Care (SPARC) in Korean Cancer Patients: Jung Hye Kwon, Sun Kyung Baek, Do Yeun Kim, Yu Jung Kim, Myung Ah Lee, Hye Jin Choi, Ja Min Byun, Jin Young Jeong, Sam H Ahmedzai, Geun-Doo Jang; Cancer Res Treat. 2021;53(1):25-31. Published online August 31, 2020; DOI: https://doi.org/10.4143/crt.2020.235

Abstract PDF Supplementary Material PubReader ePub

Purpose
This study aimed to validate the Sheffield Profile for Assessment and Referral to Care (SPARC) as an effective tool for screening palliative care needs among Korean cancer patients.
Materials and Methods
The English version of the SPARC was translated by four Korean oncologists and reconciled by a Korean language specialist and a medical oncologist fluent in English. After the first version of the Korean SPARC (K-SPARC) was developed, back-translation into English was performed by a professional translator and bilingual oncologist. The back-translated version was reviewed by the original author (S.H.A.), and modifications were made (ver. 2). The second version of the K-SPARC was tested against other questionnaires, including the Functional Assessment of Cancer Therapy-General (FACT-G) and the Edmonton Symptom Assessment System (ESAS).
Results
Thirty patients were enrolled in the pilot trial. Fifteen were male, and the median age was 64.5 years. Six patients had an Eastern Cooperative Oncology Group performance status of 2 or more. All patients except one were receiving chemotherapy. Regarding internal consistency, the Cronbach’s α scores for physical symptoms, psychological issues, religious and spiritual issues, independency and activity, family and social issues, and treatment issues were 0.812, 0.804, 0.589, 0.843, 0.754, and 0.822, respectively. The correlation coefficients between the SPARC and FACT-G were 0.479 (p=0.007) for the physical domain and –0.130 (p=0.493) for the social domain.
Conclusion
This pilot study indicates that the K-SPARC could be a reliable tool to screen for palliative care needs among Korean cancer patients. A further study to validate our findings is ongoing.

Citations

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Design, adaptation and content validation of the Sheffield Profile for Assessment and Referral for Care in Colombian Spanish (SPARC-Sp-Col)
Cindy V. Mendieta, Esther de Vries, Jose A. Calvache, Sam H. Ahmedzai, Gillian Prue, Joanne Reid
BMC Palliative Care.2026;[Epub] CrossRef
Holistic needs assessment for hospitalized patients: A cross-sectional study
Chuan-Ya Lee, Shu-Fen Chen, Chien-Ling Su, Tze-Wah Kao, Yun-Yun Chou, Tzu-Tung Kuo, Sam H. Ahmedzai, Li-Sin Hsiao, Ka-Wai Tam
Journal of Psychosomatic Research.2026; 204: 112583. CrossRef
Psychometric Validation of Sheffield Profile for Assessment and Referral to Care (SPARC) in Korean Cancer Patients
Hong Jun Kim, Eun Hee Jung, Jung Hye Kwon, Yu Jung Kim, Su-Jin Koh, Myung Ah Lee, Jung Hun Kang, Sun Young Rha, Eun Mi Nam, Sun Kyung Baek, Ha Yeon Lee, Hun Ho Song, Young-Woong Won, Hanbyul Lee
Cancer Research and Treatment.2025; 57(3): 891. CrossRef
Holistic needs assessment for hospitalized patients with kidney disease: a prospective cross-sectional study
Cynthia Hsin-Ya Chao, Ka-Wai Tam, Chien-Ling Su, Yun-Yun Chou, Tzu-Tung Kuo, Juliana Tze-Wah Kao
Journal of Nephrology.2025; 38(9): 2821. CrossRef
Translation and linguistic validation of the Sheffield Profile for Assessment and Referral for Care (SPARC) to Colombian Spanish
Socorro Moreno, Cindy V. Mendieta, Esther de Vries, Sam H. Ahmedzai, Karen Rivera, Camilo Cortes-Mora, Jose A. Calvache
Palliative and Supportive Care.2024; 22(6): 1801. CrossRef
Validation of traditional Chinese version of Sheffield Profile for Assessment and Referral for Care Questionnaire in Taiwanese patients
Ming-Chieh Tsai, Yun-Yun Chou, El-Wui Loh, Ashleigh Peng Lin, Hsueh-Chi Wu, Li-Sin Hsiao, Chia-Li Chang, Shu-Fen Chen, Sam H. Ahmedzai, Ka-Wai Tam
Journal of the Chinese Medical Association.2024; 87(1): 58. CrossRef
Validation of the Spanish translation Sheffield Profile for Assessment and Referral for Care (SPARC-Sp) at the Hospital Universitario San Jose of Popayan, Colombia
Cindy V. Mendieta, Jose A. Calvache, Martín A. Rondón, Carlos Javier Rincón-Rodríguez, Sam H. Ahmedzai, Esther de Vries
Palliative and Supportive Care.2024; 22(5): 1282. CrossRef
Co-Designing a Strategy for Implementing the SPARC Holistic Needs Assessment Tool in the Colombian Clinical Context
Cindy V. Mendieta, Esther de Vries, Jose Andrés Calvache, Sam H. Ahmedzai, Gillian Prue, Tracey McConnell, Joanne Reid
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Outpatient palliative care referral system (PCRS) for patients with advanced cancer: an impact evaluation protocol
Cinzia Brunelli, Ernesto Zecca, Alessandra Pigni, Paola Bracchi, Mariangela Caputo, Silvia Lo Dico, Viviana Fusetti, Antonino Tallarita, Cristiana Bergamini, Marta Brambilla, Alessandra Raimondi, Monica Niger, Salvatore Provenzano, Pierangela Sepe, Sara A
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Unmet needs related to the quality of life of advanced cancer patients in Korea: a qualitative study
Jeehee Pyo, Minsu Ock, Mina Lee, Juhee Kim, Jaekyung Cheon, Juhee Cho, Jung Hye Kwon, Hyeyeoung Kim, Hyeon-Su Im, Young Joo Min, Su-Jin Koh
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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 Res Treat. 2020;52(3):917-924. Published online March 23, 2020; DOI: https://doi.org/10.4143/crt.2019.740

Abstract PDF PubReader ePub

Purpose
Life-sustaining treatment (LST) decisions for patients and caregivers at the end-of-life (EOL) process are supported by the “Act on Hospice and Palliative Care and Decisions on LST for Patients at the EOL,” enforced in February 2018. Itremains unclear whether the act changes EOL decisions and LST implementation in clinical practice. For this study, we investigated patients’ decision-making regarding LSTs during the EOL process since the act’s enforcement.
Materials and Methods
Retrospective reviews were conducted on adult patients who were able to decide to terminate LST and died at Seoul National University Hospital between February 5, 2018, and February 5, 2019. We examined demographics, who made the decisions, the type and date of documentation confirming patient's LST, and whether the LST was withheld or withdrawn.
Results
Of 809 patients who were enrolled, 29% (n=231) completed forms regarding LST themselves, and 71% (n=578) needed family members to decide. The median time from confirmation of the EOL process to death and from the Advance Statement to death were 2 and 5 days, respectively (both ranges, 0 to 244). In total, 90% (n=727) of patients withheld treatment, and 10% (n=82)withdrew it. We found a higher withdrawal rate when family members made the decisions (13.3% vs. 1.7%, p < 0.001).
Conclusion
After the act’s enforcement, withdrawing LSTs became lawful and self-determination rates increased. Family members still make 71% of decisions regarding LSTs, but these are often inconsistent with the patients’ wishes; thus, further efforts are needed to integrate the new act into clinical practice.

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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

Abstract PDF PubReader ePub

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.

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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
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Comparison of Broad-Spectrum Antibiotic Use According to Hospice Utilization Among Patients with Cancer at the End of Life in South Korea: A Nationwide Analysis
Ye Sul Jeung, Hak Jun Kim, Jiwon Yu, Jeong-Han Kim, Jin-Ah Sim, Shin Hye Yoo
Journal of Hospice and Palliative Care.2026; 29(2): 41. CrossRef
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
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Symptom burden, palliative care knowledge, and palliative care needs in advanced gynecological cancer patients in Korea
Eungil Ko, Yaelim Lee
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End-of-Life Decision Making in Patients with Advanced Dementia: The Perspectives of the Korean General Population and Clinicians
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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
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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
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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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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

Abstract PDF PubReader ePub

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.

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Special Article

Development of a Community-Based Palliative Care Model for Advance Cancer Patients in Public Health Centers in Busan, Korea: Sook-Nam Kim, Soon-Ock Choi, Seong Hoon Shin, Ji-Sun Ryu, Jeong-Won Baik; Cancer Res Treat. 2017;49(3):559-568. Published online October 18, 2016; DOI: https://doi.org/10.4143/crt.2016.276

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Purpose
A feasible palliative care model for advance cancer patients is needed in Korea with its rapidly aging population and corresponding increase in cancer prevalence. This study describes the process involved in the development of a community-based palliative care (CBPC) model implemented originally in a Busan pilot project.
Materials and Methods
The model development included steps I and II of the pilot project, identification of the service types, a survey exploring the community demand for palliative care, construction of an operational infrastructure, and the establishment of a service delivery system. Public health centers (including Busan regional cancer centers, palliative care centers, and social welfare centers) served as the regional hubs in the development of a palliative care model.
Results
The palliative care project included the provision of palliative care, establishment of a support system for the operations, improvement of personnel capacity, development of an educational and promotional program, and the establishment of an assessment system to improve quality. The operational infrastructure included a service management team, provision teams, and a support team. The Busan Metropolitan City CBPC model was based on the principles of palliative care as well as the characteristics of public health centers that implemented the community health projects.
Conclusion
The potential use of the Busan CBPC model in Korea should be explored further through service evaluations.

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International Journal of Medical Students.2023; 11(4): 294. CrossRef
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Structural Analysis on Quality of Life for Terminal Cancer Patients provided Hospice and Palliative Care Services in Community Health Centers
Sook-Nam Kim, Soon-Ock Choi, Ji-Seon Ryu, Jung-Rim Kim
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Evaluation of Outcomes of the Busan Community-based Palliative Care Project in Korea
Soon-Ock Choi, Sook-Nam Kim, Seong-Hoon Shin, Ji-Seon Ryu, Jeong-Won Baik, Jung-Rim Kim, Nae-Hyeon Kim
Asian Nursing Research.2018; 12(4): 286. 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.

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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
Cancer Research and Treatment.2026; 58(1): 339. CrossRef
Improving Quality of End-of-Life Care Through the K-HOPE Consultative Palliative Care Model: A Prospective Study in a Tertiary Hospital
Yoo Jeong Lee, In Cheol Hwang, Eun Jeong Lee, Soon-Young Hwang, Youn Seon Choi
Current Oncology.2026; 33(4): 213. CrossRef
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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Frequency and Outcome of Neuroleptic Rotation in the Management of Delirium in Patients with Advanced Cancer: Seong Hoon Shin, David Hui, Gary Chisholm, Jung Hun Kang, Julio Allo, Janet Williams, Eduardo Bruera; Cancer Res Treat. 2015;47(3):399-405. Published online November 24, 2014; DOI: https://doi.org/10.4143/crt.2013.229

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Purpose
The response to haloperidol as a first-line neuroleptic and the pattern of neuroleptic rotation after haloperidol failure have not been well defined in palliative care. The purpose of this study was to determine the efficacy of haloperidol as a first-line neuroleptic and the predictors associated with the need to rotate to a second neuroleptic. Materials and Methods We conducted a retrospective review of the charts of advanced cancer patients admitted to our acute palliative care unit between January 2012 and March 2013. Inclusion criteria were a diagnosis of delirium and first-line treatment with haloperidol. Results Among 167 patients with delirium, 128 (77%) received only haloperidol and 39 (23%) received a second neuroleptic. Ninety-one patients (71%) who received haloperidol alone improved and were discharged alive. The median initial haloperidol dose was 5 mg (interquartile ranges [IQR], 3 to 7 mg) and the median duration was 5 days (IQR, 3 to 7 days). The median final haloperidol dose was 6 mg (IQR, 5 to 7 mg). A lack of treatment efficacy was the most common reason for neuroleptic rotation (87%). Significant factors associated with neuroleptic rotation were inpatient mortality (59% vs. 29%, p=0.001), and being Caucasian (87% vs. 62%, p=0.014). Chlorpromazine was administered to 37 patients (95%) who were not treated successfully by haloperidol. The median initial chlorpromazine dose was 150 mg (IQR, 100 to 150 mg) and the median duration was 3 days (IQR, 2 to 6 days). Thirteen patients (33%) showed reduced symptoms after the second neuroleptic. Conclusion Neuroleptic rotation from haloperidol was only required in 23% of patients with delirium and was associated with inpatient mortality and white race.

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Agitation and delirium in the last days of life: terminology and management—systematic review and narrative synthesis
Rebecca A Hatton, Gilli Erez, Miriam J Johnson
BMJ Supportive & Palliative Care.2026; : spcare-2025-005872. CrossRef
Proportional Sedation for Persistent Agitated Delirium in Palliative Care
David Hui, Allison De La Rosa, Jaw-Shiun Tsai, Shao-Yi Cheng, Egidio Del Fabbro, Anita Thankam Thomas Kuzhiyil, Kendra Rowe, Ahsan Azhar, Thuc Nguyen, Michael Tang, Chien-An Yao, Hsien-Liang Huang, Jen-Kuei Peng, Wen-Yu Hu, Sonal Admane, Rony Dev, Minxing
JAMA Oncology.2025; 11(9): 1031. CrossRef
Naming racism as a root cause of inequities in palliative care research: a scoping review
Kavita Algu, Joshua Wales, Michael Anderson, Mariam Omilabu, Thandi Briggs, Allison M. Kurahashi
BMC Palliative Care.2024;[Epub] CrossRef
Management of Physical Symptoms in Patients with Advanced Cancer during the Last Weeks and Days of Life
Ahsan Azhar, David Hui
Cancer Research and Treatment.2022; 54(3): 661. CrossRef
Chlorpromazine as Treatment for Refractory Agitation Associated with Pediatric Delirium
Shin Young Kim, Shari Simone, Omayma A. Kishk, Ana Lia Graciano, Hyunuk Seung, Sarah Edwards
The Journal of Pediatric Pharmacology and Therapeutics.2022; 27(8): 725. CrossRef
Pharmacological and non-pharmacological treatment of delirium in an oncological hospital service: an integrative review
Luciana Aparecida Vieira Louro, João Francisco Possari, Antônio Fernandes Costa Lima
Revista Brasileira de Enfermagem.2021;[Epub] CrossRef
Neuroleptic strategies for terminal agitation in patients with cancer and delirium at an acute palliative care unit: a single-centre, double-blind, parallel-group, randomised trial
David Hui, Allison De La Rosa, Annie Wilson, Thuc Nguyen, Jimin Wu, Marvin Delgado-Guay, Ahsan Azhar, Joseph Arthur, Daniel Epner, Ali Haider, Maxine De La Cruz, Yvonne Heung, Kimberson Tanco, Shalini Dalal, Akhila Reddy, Janet Williams, Sapna Amin, Terri
The Lancet Oncology.2020; 21(7): 989. CrossRef
A Scoping Review to Map Empirical Evidence Regarding Key Domains and Questions in the Clinical Pathway of Delirium in Palliative Care
Peter G. Lawlor, Nicole A. Rutkowski, Alistair R. MacDonald, Mohammed T. Ansari, Lindsey Sikora, Franco Momoli, Salmaan Kanji, David K. Wright, Erin Rosenberg, Annmarie Hosie, Jose L. Pereira, David Meagher, Jill Rice, John Scott, Shirley H. Bush
Journal of Pain and Symptom Management.2019; 57(3): 661. CrossRef
Prevalencia de delirium mediante la escala Memorial Delirium Assessment Scale (MDAS) en pacientes oncológicos avanzados ingresados en una Unidad de Cuidados Paliativos. Factores de riesgo, reversibilidad y tratamiento recibido
Verónica Díaz García, Miriam López Pérez, Yolanda Zuriarrain Reyna
Medicina Paliativa.2018; 25(4): 245. CrossRef
Clinical Assessment and Management of Delirium in the Palliative Care Setting
Shirley Harvey Bush, Sallyanne Tierney, Peter Gerard Lawlor
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Delirium Management: Diagnosis, Assessment, and Treatment in Palliative Care
Min Seok Seo, Yong Joo Lee
The Korean Journal of Hospice and Palliative Care.2016; 19(3): 201. CrossRef
Neuroleptics in the management of delirium in patients with advanced cancer
David Hui, Rony Dev, Eduardo Bruera
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Acute symptomatic complications among patients with advanced cancer admitted to acute palliative care units: A prospective observational study
David Hui, Renata dos Santos, Suresh Reddy, Maria Salete de Angelis Nascimento, Donna S Zhukovsky, Carlos Eduardo Paiva, Shalini Dalal, Everaldo Donizeti Costa, Paul Walker, Heloisa Helena Scapulatempo, Rony Dev, Camila Souza Crovador, Maxine De La Cruz,
Palliative Medicine.2015; 29(9): 826. CrossRef

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Case Reports

Metastatic Skin Lesions on Lower Extremities in a Patient with Recurrent Serous Papillary Ovarian Carcinoma: A Case Report and Literature Review: Moon-Kyung Kim, Seo-Hee Kim, Yoo-Young Lee, Chel Hun Choi, Tae-Joong Kim, Jeoung-Won Lee, Je-Ho Lee, Duk-Soo Bae, Byoung-Gie Kim; Cancer Res Treat. 2012;44(2):142-145. Published online June 30, 2012; DOI: https://doi.org/10.4143/crt.2012.44.2.142

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Clinical observation of skin metastasis in ovarian cancer cases is relatively uncommon. And distant metastatic skin lesions including the extremities are much rarer still as most metastatic skin lesions are located in the skin in the abdominal wall adjacent to where the primary ovarian tumors exist. We report the case of a 60-year-old woman who presented skin lesions on both lower extremities as a consequence of the metastasis of serous papillary adenocarcinoma of the ovary. She presented with erythematous and painful cutaneous nodules on both upper legs and in the inguinal area 42 months after initial diagnosis of ovarian cancer. Skin biopsy revealed metastasis of adenocarcinoma in the dermis. She was treated with surgical excision and systemic chemotherapy. Literature review has suggested that a combined modality approach including surgical excision and chemotherapy may be useful in the management of skin metastases due to ovarian cancer.

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Andreea Cătălina Tinca, Bianca Andreea Lazar, Andreea Raluca Cozac-Szőke, Georgian Nicolae Radu, Simina Petra Simion, Diana Maria Chiorean, Irina Bianca Kosovski, Adrian Horațiu Sabău, Raluca Niculescu, Iuliu Gabriel Cocuz, Raluca-Diana Hagău, Emoke Andre
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Jingheng Zhang, Wenfeng He, Zhenhua Zhang, Hui Dong, Xiangyu Deng, Qinglian Wen, Dan Li
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Metastasis of ovarian cancer to nasal skin and skin on the trunk: a rare case report
Chen Chen, Ouyang Yingyao, Xiang Yan, He Qianru, Wang Hong, Chen Chen, Yang Lei
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A Rare and Sinister Presentation of Cutaneous Metastasis over Right Lower Limb in a Case of Ovarian Carcinoma
Preema Sinha, Parul Kamboj, Anamika Sinha, Juhi Sharma
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Clinicopathologic features of cutaneous metastases from internal malignancies
Hyeong Mok Kwon, Gyu Yeong Kim, Dong Hoon Shin, Young Kyung Bae
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Rare Sites Metastasis in Ovarian Carcinoma: a Compilation of 3 Case Reports
Megha Nandwani, Debabrata Barmon, Dimpy Begum, Amal C. Kataki
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Cutaneous metastasis of PD-L1 positive ovarian carcinoma
Victoria Hastings, Jennifer McEachron, Marguax J. Kanis
Gynecologic Oncology Reports.2020; 33: 100607. CrossRef
PET/CT for Evaluation of Ovarian Cancer
Jukka Kemppainen, Johanna Hynninen, Johanna Virtanen, Marko Seppänen
Seminars in Nuclear Medicine.2019; 49(6): 484. CrossRef
Cutaneous Metastases in Ovarian Cancer
Isao Otsuka
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Skin metastases in ovarian clear cell adenocarcinoma: a case report and a review of the literature
Gina Nam, Young-mee Lim, Min Sun Cho, Junghye Lee, Yun Hwan Kim
Obstetrics & Gynecology Science.2017; 60(6): 593. CrossRef
Two independent incidences of skin metastases in the umbilicus and abdominal wall in ovarian serous adenocarcinoma
Hongyan Cheng, Chunmei Gao, Runtong Zhang, Zhaojie Yang, Guiyu Zhang
Medicine.2017; 96(49): e9118. CrossRef
Cutaneous metastases from adenocarcinoma of the ovary
Heidi H. McDonald, Milton R. Moore, Jeffrey J. Meffert
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Ovarian carcinoma presenting as cutaneous nasal metastasis
Ana Marta António, João Vitor Alves, João Goulão, Elvira Bártolo
Anais Brasileiros de Dermatologia.2016; 91(5 suppl 1): 101. CrossRef

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Recurrent and Metastatic Trichilemmal Carcinoma of the Skin Over the Thigh: A Case Report: Hyon Seung Yi, Sun Jin Sym, Jinny Park, Eun Kyung Cho, Seung-Yeon Ha, Dong Bok Shin, Jae Hoon Lee; Cancer Res Treat. 2010;42(3):176-179. Published online September 30, 2010; DOI: https://doi.org/10.4143/crt.2010.42.3.176

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Trichilemmal carcinoma (TC) is an uncommon cutaneous neoplasm that develops from the external root sheath of the hair follicle. It is considered to be a low-grade carcinoma with low metastatic potential. Local recurrence and metastasis are rare after surgical excision. We report here on a case of metastatic TC in the skin over the thigh, and this tumor was treated with cisplatin and cyclophosphamide combination chemotherapy.

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