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Annals of Oncology Advance Access published online on September 2, 2008
Annals of Oncology, doi:10.1093/annonc/mdn602
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© The Author 2008. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oxfordjournals.org

Trends in quality of end-of-life care for Taiwanese cancer patients who died in 2000–2006

S. T. Tang1,*, S.-C. Wu2, Y.-N. Hung3, E.-W. Huang4, J.-S. Chen5 and T.-W. Liu6

1 Graduate School of Nursing, Chang Gung University and Department of Nursing, Kaohsiung Chung Gung Memorial Hospital, Taoyuan
2 Institute of Health and Welfare Policy
3 Institute of Public Health, National Yang-Ming University
4 Department of Information Management, National Taipei College of Nursing, Taipei
5 Division of Hematology-Oncology, Chang Gung Memorial Hospital, Taoyuan
6 National Institute of Cancer Research, Zhunan Town, Taiwan, Republic of China

* Correspondence to: Prof. S. T. Tang, Graduate School of Nursing, Chang Gung University, 259 Wen-Hwa 1st Road, Kwei-Shan, Tao-Yuan, Taiwan 333, Republic of China and Department of Nursing, Kaohsiung Chung Gung Memorial Hospital, Taiwan. Tel: +886-3-211-8800-3417; Fax: +886-3-211-8420; E-mail: sttang{at}mail.cgu.edu.tw

Background: Quality of end-of-life care received by cancer patients has never been explored in an entire Asian country for all ages and cancer groups.

Patients and methods: Retrospective cohort study to examine trends in quality of end-of-life care among a cohort of 242 530 Taiwanese cancer patients who died in 2000–2006.

Results: In the last month of life, cancer care tended to become increasingly aggressive as shown by (i) intensive use of chemotherapy (15.45%–17.28%), (ii) frequent emergency room visits (15.69%–20.99%) and >14-day hospital stays (41.48%–46.20%), (iii) admissions to intensive care units (10.04%–12.41%), and (iv) hospital deaths (59.11%–65.40%). Use of cardiopulmonary resuscitation (13.09%–8.41%), intubation (26.01%–21.07%), and mechanical ventilation (27.46%–27.05%) decreased, whereas use of hospice services increased considerably (7.34%–16.83%). Among those receiving hospice services, rates of referrals to hospice services in the last 3 days of life decreased from 17.88% to 17.13% but remained steady after adjusting for selected covariates.

Conclusions: The quality of end-of-life care for Taiwanese cancer decedents was substantially inferior to that previously reported and to that recommended as benchmarks for not providing overly aggressive care near the end of life.

administrative databases analysis, aggressiveness of care near the end of life, population-based study, quality of end-of-life care

Received for publication May 7, 2008. Revision received July 25, 2008. Accepted for publication August 4, 2008.


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