title: The Understanding of Terminal Cancer and Its Relationship with Attitudes toward End-of-Life Care Issues.
abstract: Although terminal cancer is a widely used term, its meaning varies, which may lead to different attitudes toward end-of-life issues. The study was conducted to investigate differences in the understanding of terminal cancer and determine the relationship between this understanding and attitudes toward end-of-life issues.
  
  
  
  A questionnaire survey was performed between 2008 and 2009. A total of 1242 cancer patients, 1289 family caregivers, 303 oncologists from 17 hospitals, and 1006 participants from the general population responded.
  
  
  
  A "6-month life expectancy" was the most common understanding of terminal cancer (45.6%), followed by "treatment refractoriness" (21.1%), "metastatic/recurrent disease" (19.4%), "survival of a few days/weeks" (11.4%), and "locally advanced disease" (2.5%). The combined proportion of "treatment refractoriness" and "6-month life expectancy" differed significantly between oncologists and the other groups combined (76.0% v. 65.9%, P = 0.0003). Multivariate analyses showed that patients and caregivers who understood terminal cancer as "survival of a few days/weeks" showed more negative attitudes toward disclosure of terminal status compared with participants who chose "treatment refractoriness" (adjusted odds ratio [aOR] 0.42, 95% confidence interval [CI] 0.22-0.79 for patients; aOR 0.34, 95% CI 0.18-0.63 for caregivers). Caregivers who understood terminal cancer as "locally advanced" or "metastatic/recurrent disease" showed a significantly lower percentage of agreement with withdrawal of futile life-sustaining treatment compared with those who chose "treatment refractoriness" (aOR 0.19, 95% CI 0.07-0.54 for locally advanced; aOR 0.39, 95% CI 0.21-0.72 for metastatic/recurrent).
  
  
  
  The understanding of terminal cancer varied among the 4 participant groups. It was associated with different preferences regarding end-of-life issues. Standardization of these terms is needed to better understand end-of-life care.
authors: Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea (JKL, DSH)
authors: June Koo
authors: JK
authors: Lee
authors: Department of Medical Science, Seoul National University College of Medicine, Seoul, Korea (YHY)
authors: Young Ho
authors: YH
authors: Yun
authors: Department of Family Medicine, Seoul National University Hospital, Seoul, Korea (ARA)
authors: Ah Reum
authors: AR
authors: An
authors: Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea (JKL, DSH)
authors: Dae Seog
authors: DS
authors: Heo
authors: Department of Surgery, Yonsei University Medical Center, Yonsei University College of Medicine, Seoul, Korea (BWP)
authors: Byeong-Woo
authors: BW
authors: Park
authors: Department of Obstetrics and Gynecology, School of Medicine, Keimyung University, Daegu, Korea (C-HC)
authors: Chi-Heum
authors: CH
authors: Cho
authors: Department of Surgery, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Korea (SK)
authors: Sung
authors: S
authors: Kim
authors: Quality of Life Improvement Team and Department of Oncology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea (DHL)
authors: Dae Ho
authors: DH
authors: Lee
authors: Section of Medical Oncology, Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea (SNL)
authors: Soon Nam
authors: SN
authors: Lee
authors: Department of Surgery, Anam Medical Center, Korea University, School of Medicine, Seoul, Korea (ESL)
authors: Eun Sook
authors: ES
authors: Lee
authors: Department of Internal Medicine, Postgraduate Medical School, Gyeongsang National University, Jinju, Korea (JHK)
authors: Jung Hun
authors: JH
authors: Kang
authors: Department of Medical Oncology/Hematology, Kyung Hee University Hospital, Seoul, Korea (S-YK)
authors: Si-Young
authors: SY
authors: Kim
authors: Department of Hematooncology, Fatima Hospital, Daegu, Korea (JLL)
authors: Jung Lim
authors: JL
authors: Lee
authors: Department of Radiation Oncology, Yonsei University College of Medicine, Yonsei Cancer Center, Seoul, Korea (CGL)
authors: Chang Geol
authors: CG
authors: Lee
authors: Kwangju Christian Hospital, Kwangju, Korea (YKL)
authors: Yeun Keun
authors: YK
authors: Lim
authors: Division of Hematooncology, Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon, Korea (SK)
authors: Samyong
authors: S
authors: Kim
authors: Department of Internal Medicine, Hongcheon Asan Hospital, Hongcheon, Korea (JSC)
authors: Jong Soo
authors: JS
authors: Choi
authors: Good Samaritan Hospital, Pohang, Korea (HSJ)
authors: Hyun Sik
authors: HS
authors: Jeong
authors: Department of Radiation Oncology, Ajou University School of Medicine, Suwon, Korea (MC).
authors: Mison
authors: M
authors: Chun
mesh_terms: D000328:Adult; D000368:Aged; D001290:Attitude; D017028:Caregivers / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008495:Medical Oncology; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology*; D056910:Republic of Korea; D012959:Socioeconomic Factors; D013727:Terminal Care / Q000523:psychology*; D009626:Terminology as Topic; D055815:Young Adult
keywords: end of life; life-sustaining treatment; palliative care; terminal cancer; terminology