Quality of end-of-life treatment for cancer patients in general wards and the palliative care unit at a regional cancer center in Japan: a retrospective chart review
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In Japan, most cancer patients die in the hospital. The aim of this study was to assess the quality of end-of-life treatment for dying cancer patients in general wards and palliative care unit (PCU).
Materials and methods
A retrospective chart review study was conducted. The following data on cancer patients who died in general wards (N = 104) and PCU (N = 201) at a regional cancer center were collected: do-not-resuscitate (DNR) decisions, treatments in the last 48 h of life, and aggressiveness of cancer care for dying patients.
DNR orders were documented for most patients (94% in general wards, 98% in PCU, p = 0.067) and families usually consented (97%, 97%, p = 0.307). Comparison of general wards with PCU showed that, in the last 48 h of life, significantly more patients in general wards received life-sustaining treatment (resuscitation, 3.8%, 0%, p = 0.001; mechanical ventilation, 4.8%, 0%, p = 0.004), large volume hydration (>1,000 ml/day, 67%, 10%, p < 0.001) with continuous administration (83%, 5%, p = 0.002) and fewer palliative care drugs (strong opioids, 68%, 92%, p < 0.001; corticosteroids, 49%, 70%, p < 0.001; nonsteroidal anti-inflammatory drugs, 34%, 85%, p < 0.001). Regarding aggressiveness of cancer care, patients received a new chemotherapy regimen within 30 days of death (3.0%), chemotherapy within 14 days of death (4.3%), and intensive care unit admission in the last month of life (3.3%).
We found that families, not patients, consented to DNR, and life-sustaining treatments were appropriately withheld; however, patients on general wards received excessive hydration, and the use of palliative care drugs could be improved. Application of our findings can be used to improve clinical care in general wards.
KeywordsQuality of health care Palliative care Terminal care Decision making Retrospective study Neoplasm Japan
This research was supported by a grant from Health and Labor Science Research Grants, Third Term Comprehensive Control Research for Cancer. We would like to express our gratitude to the hospital staff for their cooperation in this study. The author would also like to thank Keiko Kazuma, RN, PhD (Department of Adult Nursing/Palliative Care Nursing, University of Tokyo) for contributing time and expertise to this study.
- 16.Braga S, Miranda A, Fonseca R et al (2007) The aggressiveness of cancer care in the last three months of life: a retrospective single centre analysis. Psychooncology 16(9):863–868Google Scholar
- 17.Statistics and Information Dept., Minister’s Secretariat, Ministry of Health, Labour and Welfare (2006) Vital statistics of Japan 2005 (in Japanese). Ministry of Health, Labour and Welfare, TokyoGoogle Scholar