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Japanese Journal of Clinical Oncology Advance Access originally published online on April 14, 2008
Japanese Journal of Clinical Oncology 2008 38(5):381-386; doi:10.1093/jjco/hyn031
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© The Author (2008). Published by Oxford University Press. All rights reserved

Aggressiveness of Cancer-Care near the End-of-Life in Korea

Bhumsuk Keam1, Do-Youn Oh1, Se-Hoon Lee1, Dong-Wan Kim1, Mi Ra Kim1, Seock-Ah Im1, Tae-You Kim1, Yung-Jue Bang1 and Dae Seog Heo1,2

1 Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul
2 Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea

For reprints and all correspondence: Dae Seog Heo, Department of Internal Medicine, Seoul National University College of Medicine, 28 Yongon-Dong, Chongno-Gu, Seoul 110-744, Republic of Korea. E-mail: heo1013{at}snu.ac.kr

Received December 6, 2007; accepted March 24, 2008

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.

Key Words: aggressiveness • end-of-life • hospice • palliative chemotherapy

Presented in part at the 42nd Annual Meeting of the American Society of Clinical Oncology, Atlanta, GA, June 2–6, 2006.


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