Cancer Treatment near the End-of-Life Becomes More Aggressive: Changes in Trend during 10 Years at a Single Institute
2
조회
0
다운로드
8
인용
0
참고문헌
키워드
초록
Purpose The purpose of this study was to investigate and compare cancer treatment near theend-of-life (EOL) over a 10-year period. Materials and MethodsPatients with advanced solid cancer at Seoul National University Hospital who receivedpalliative chemotherapy and had died were enrolled. We categorized the consecutivepatients according to two time periods: 2002 (n=57) and 2012 (n=206). Aggressivenessof cancer treatment near the EOL was evaluated. ResultsThe median patient age was 62, and 65.4% of patients (n=172) were male. Time from thelast chemotherapy to death (TCD) was found to have been significantly shortened, from66.0 days to 34.0 days during 10 years (p < 0.001); 17% of patients received moleculartargeted agents as the last chemotherapy regimen in 2012. The proportion of patients whoreceived intensive care unit care within the last month increased from 1.8% in 2002 to19.9% in 2012 (p < 0.001), and emergency room visits within the last month also increasedfrom 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 userswas associated with shortened TCD (hazard ratio, 2.564; p=0.002). ConclusionCancer treatment near the EOL became more aggressive over 10 years.
Abstract
Purpose The purpose of this study was to investigate and compare cancer treatment near theend-of-life (EOL) over a 10-year period. Materials and MethodsPatients with advanced solid cancer at Seoul National University Hospital who receivedpalliative chemotherapy and had died were enrolled. We categorized the consecutivepatients according to two time periods: 2002 (n=57) and 2012 (n=206). Aggressivenessof cancer treatment near the EOL was evaluated. ResultsThe median patient age was 62, and 65.4% of patients (n=172) were male. Time from thelast chemotherapy to death (TCD) was found to have been significantly shortened, from66.0 days to 34.0 days during 10 years (p < 0.001); 17% of patients received moleculartargeted agents as the last chemotherapy regimen in 2012. The proportion of patients whoreceived intensive care unit care within the last month increased from 1.8% in 2002 to19.9% in 2012 (p < 0.001), and emergency room visits within the last month also increasedfrom 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 userswas associated with shortened TCD (hazard ratio, 2.564; p=0.002). ConclusionCancer treatment near the EOL became more aggressive over 10 years.
참고문헌 (25)
- "The 10 leading causes of death in the world, 2000 and 2011" (2013)[URL]
- Annual report on the cause of death statistics, "Statistics Korea", Statistics Korea, 127~143 (2013)
- Sacred Congregation for the Doctrine of the Faith, "Vatican declaration on euthanasia", Origins, 10, pp.154~157 (1980)
- Earle CC, "Trends in the aggressiveness of cancer care near the end of life", J Clin Oncol, 22, pp.315~321 (2004)
- Nieder C, "Active anticancer treatment during the final month of life in patients with non-small cell lung cancer", Anticancer Res, 34, pp.1015~1020 (2014)
- Emanuel EJ, "Chemotherapy use among Medicare beneficiaries at the end of life", Ann Intern Med, 138, pp.639~643 (2003)
- Yun YH, "Chemotherapy use and associated factors among cancer patients near the end of life", Oncology, 72, pp.164~171 (2007)
- Nappa U, "Palliative chemotherapy during the last month of life", Ann Oncol, 22, pp.2375~2380 (2011)
- Wright AA, "Associations between end-of-life discussions, patient mental health, medical care near death, and caregiver bereavement adjustment", JAMA, 300, pp.1665~1673 (2008)
- Casarett DJ, "The terrible choice : re-evaluating hospice eligibility criteria for cancer", J Clin Oncol, 27, pp.953~959 (2009)
- Teno JM, "Family perspectives on end-of-life care at the last place of care", JAMA, 291, pp.88~93 (2004)
- Keam B, "Aggressiveness of cancer-care near the end-of-life in Korea", Jpn J Clin Oncol, 38, pp.381~386 (2008)
- Hui D, "Targeted agent use in cancer patients at the end of life", J Pain Symptom Manage, 46, pp.1~8 (2013)
- Soh TI, "Targeted therapy at the end of life in advanced cancer patients", J Palliat Med, 15, pp.991~997 (2012)
- Wong AS, "Targeted therapy at the end of life for patients with lung cancer", J Palliat Med, 13, pp.945~948 (2010)
- Walker H, "Resource use and costs of end-of-Life", palliative care : Ontario adult cancer patients dying during 2002 and 2003, 2011, pp.27, 79~88
- Morishima T, "Association of healthcare expenditures with aggressive versus palliative care for cancer patients at the end of life : a cross-sectional study using claims data in Japan", Int J Qual Health Care, 26, pp.79~86 (2014)
- Zhang B, "Health care costs in the last week of life : associations with end-of-life conversations", Arch Intern Med, 169, pp.480~488 (2009)
- Jung HM, "Health economics of a palliative care unit for terminal cancer patients : a retrospective cohort study", Support Care Cancer, 20, pp.29~37 (2012)
- Temel JS, "Early palliative care for patients with metastatic non-small-cell lung cancer", N Engl J Med, 363, pp.733~742 (2010)
- "Evaluation of the effect on medical service of the enforcement of health insurance on cancer" (2011)[URL]
- 임진화, "민간의료보험이 암 환자의 의료이용과 의료비에 미치는 영향: 일개 암전문의료기관의 우리나라 주요 암종을 중심으로", 예방의학회지, 40(4), pp.329~335 (2007), 대한예방의학회
- Chirikos TN, "Cancer economics: on variations in the costs of treating cancer", Cancer Control, 9, pp.59~66 (2002)
- Colla CH, "Impact of payment reform on chemotherapy at the end of life", Am J Manag Care, 18, pp.e200~208 (2012)
- "OECD Health Data 2013" (2013)[URL]