title: Cancer Treatment near the End-of-Life Becomes More Aggressive: Changes in Trend during 10 Years at a Single Institute.
abstract: OBJECTIVE
  The purpose of this study was to investigate and compare cancer treatment near the end-of-life (EOL) over a 10-year period.
  
  
  METHODS
  Patients with advanced solid cancer at Seoul National University Hospital who received palliative chemotherapy and had died were enrolled. We categorized the consecutive patients according to two time periods: 2002 (n=57) and 2012 (n=206). Aggressiveness of cancer treatment near the EOL was evaluated.
  
  
  RESULTS
  The median patient age was 62, and 65.4% of patients (n=172) were male. Time from the last chemotherapy to death (TCD) was found to have been significantly shortened, from 66.0 days to 34.0 days during 10 years (p < 0.001); 17% of patients received molecular targeted agents as the last chemotherapy regimen in 2012. The proportion of patients who received intensive care unit care within the last month increased from 1.8% in 2002 to 19.9% in 2012 (p < 0.001), and emergency room visits within the last month also increased from 22.8% to 74.8% (p < 0.001). Although hospice referral increased from 9.1% to 37.4% (p < 0.001), timing of referral was delayed from median 53 days to 8 days before death (p=0.004). Use of targeted agents as the last chemotherapy for over-two-regimen users was associated with shortened TCD (hazard ratio, 2.564; p=0.002).
  
  
  CONCLUSIONS
  Cancer treatment near the EOL became more aggressive over 10 years.
authors: Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
authors: Younak
authors: Y
authors: Choi
authors: Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.|Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.
authors: Bhumsuk
authors: B
authors: Keam
authors: Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.|Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.
authors: Tae Min
authors: TM
authors: Kim
authors: Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.|Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.
authors: Se-Hoon
authors: SH
authors: Lee
authors: Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.|Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.
authors: Dong-Wan
authors: DW
authors: Kim
authors: Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.|Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.
authors: Dae Seog
authors: DS
authors: Heo
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy*; D015996:Survival Rate; D013727:Terminal Care / Q000639:trends*
keywords: Hospices; Targeted molecular therapy; Terminal care