title: Quality of end-of-life treatment for cancer patients in general wards and the palliative care unit at a regional cancer center in Japan: a retrospective chart review.
abstract: OBJECTIVE
  In Japan, most cancer patients die in the hospital. The aim of this study was to assess the quality of end-of-life treatment for dying cancer patients in general wards and palliative care unit (PCU).
  
  
  METHODS
  A retrospective chart review study was conducted. The following data on cancer patients who died in general wards (N = 104) and PCU (N = 201) at a regional cancer center were collected: do-not-resuscitate (DNR) decisions, treatments in the last 48 h of life, and aggressiveness of cancer care for dying patients.
  
  
  RESULTS
  DNR orders were documented for most patients (94% in general wards, 98% in PCU, p = 0.067) and families usually consented (97%, 97%, p = 0.307). Comparison of general wards with PCU showed that, in the last 48 h of life, significantly more patients in general wards received life-sustaining treatment (resuscitation, 3.8%, 0%, p = 0.001; mechanical ventilation, 4.8%, 0%, p = 0.004), large volume hydration (>1,000 ml/day, 67%, 10%, p < 0.001) with continuous administration (83%, 5%, p = 0.002) and fewer palliative care drugs (strong opioids, 68%, 92%, p < 0.001; corticosteroids, 49%, 70%, p < 0.001; nonsteroidal anti-inflammatory drugs, 34%, 85%, p < 0.001). Regarding aggressiveness of cancer care, patients received a new chemotherapy regimen within 30 days of death (3.0%), chemotherapy within 14 days of death (4.3%), and intensive care unit admission in the last month of life (3.3%).
  
  
  CONCLUSIONS
  We found that families, not patients, consented to DNR, and life-sustaining treatments were appropriately withheld; however, patients on general wards received excessive hydration, and the use of palliative care drugs could be improved. Application of our findings can be used to improve clinical care in general wards.
authors.affiliation: Department of Adult Nursing/Palliative Care Nursing, School of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Bunkyo, Tokyo, Japan. kazukisato-tky@umin.ac.jp
authors.forename: Kazuki
authors.initials: K
authors.lastname: Sato
authors.forename: Mitsunori
authors.initials: M
authors.lastname: Miyashita
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Morita
authors.forename: Makiko
authors.initials: M
authors.lastname: Sanjo
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Shima
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Uchitomi
mesh_terms: D000328:Adult; D000368:Aged; D003657:Decision Making; D005260:Female; D006757:Hospital Units; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000628:therapy*; D010166:Palliative Care / Q000592:standards*; D011787:Quality of Health Care; D016414:Resuscitation Orders; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000592:standards*