Aggressiveness of cancer-care near the end-of-life in Korea.
OBJECTIVE
The aim of this study was to examine the appropriateness of chemotherapy and care in Korean cancer patients near the end-of-life.


METHODS
We designed a retrospective cohort composed of patients diagnosed as having metastatic cancer and who received palliative chemotherapy at Seoul National University Hospital in 2002. Two hundred and ninety-eight patients who died of cancer were evaluated in terms of the appropriateness of the cancer-care they received, including chemotherapy.


RESULTS
Median duration of chemotherapy was 6.02 months compared with 8.67 months for median overall survival. The median period between last chemotherapy and death was 2.02 months. Of the 298 patients, 50.3% received chemotherapy during the last 2 months of life. Furthermore, 17 patients (5.7%) died within 2 weeks after receiving chemotherapy. The proportion who visited an emergency room (ER) more than once during the last months of life was 33.6%, and the average number of ER visits after a diagnosis of cancer was 1.72. Only 9.1% of patients were referred to a hospice consultation service and only 11.7% of patients agreed with written DNR.


CONCLUSIONS
Among patients who died of cancer, significant proportions were found to have received chemotherapy up to the end-of-life and to have visited ERs. Hospice referrals and discussions about DNR were not conducted well during the end-of-life period in Korea.
Keam
Bhumsuk
B
Department of Internal Medicine, Seoul National University College of Medicine, 28 Yongon-Dong, Chongno-Gu, Seoul 110-744, Republic of Korea.
Oh
Do-Youn
DY
Lee
Se-Hoon
SH
Kim
Dong-Wan
DW
Kim
Mi Ra
MR
Im
Seock-Ah
SA
Kim
Tae-You
TY
Bang
Yung-Jue
YJ
Heo
Dae Seog
DS
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002173:Cancer Care Facilities; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007723:Korea; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy* / Q000401:mortality; D010166:Palliative Care / Q000379:methods*; D016019:Survival Analysis; D013727:Terminal Care / Q000379:methods*; D028761:Withholding Treatment