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Changes in the treatment rate of patients newly diagnosed with stage IV cancer near the end of life from 2012 to 2017 in Korea
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Kyuwoong Kim
 , Hyun Jung Jho, So Jung Park, Bohyun Park, Jin Young Choi
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Epidemiol Health. 2023;45:e2023021. Published online February 14, 2023
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DOI: https://doi.org/10.4178/epih.e2023021
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 Abstract
Summary
 PDF Supplementary Material
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Abstract
OBJECTIVES
This study aimed to evaluate changes in the cancer treatment rate among patients newly diagnosed with stage IV cancer using socio-demographic and clinical subgroups in a nationwide cohort of Korean patients.
METHODS This retrospective, national-level study used the Korea Central Cancer Registry (KCCR), which is linked to the National Health Insurance Service (NHIS) database, from January 1, 2012 to December 31, 2017. The records of patients newly diagnosed with stage IV of the 5 cancers with the highest cancer-related mortality rate were identified to analyze changes in the treatment rate. The main outcome examined in this study was the change in the cancer treatment rate between 2012 and 2017, as measured using the annual percent change (APC).
RESULTS A total of 106,082 patients with newly diagnosed gastric, colorectal, liver, pancreatic, and lung cancers at the end of life (EoL) were identified from the KCCR-NHIS database. Of these patients, 76,533 (72.1%) received cancer treatment. Over the study period (2012-2017), the proportion of patients who received cancer treatment at EoL decreased by 8.3%, with an APC of -2.1% (95% confidence interval, -2.6 to -1.6). This declining trend of cancer treatment among patients with advanced cancer stage at EoL was consistent among socio-demographic and clinical subgroups.
CONCLUSIONS The proportion of untreated patients with stage IV cancer is increasing in the Korea. For patients who are not undergoing standard cancer treatment near EoL, an alternative care plan, such as early palliative care, should be considered.
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Summary
Korean summary
국민건강보험공단과 중앙암등록본부 자료를 활용하여 4기 암환자의 암 치료 비율 추이를 분석한 결과 2012년부터 2017년까지 위암, 대장암, 간암, 췌장암, 폐암으로 진단받은 4기 암환자들의 암 치료 비율의 연간비율변화는 8.3% 감소하는 것으로 나타났다. 이러한 결과는 인구사회학적 및 임상적 특성에 관계없이 일관되었다. 본 연구결과는 말기에 가까운 4기 암 환자들이 표준 치료를 받지 못하는 경우, 조기 완화의료와 같은 대안적인 계획을 고려할 필요가 있음을 시사한다.
Key Message
● Between 2012 and 2017, there was a significant decrease in the treatment rate among these patients, though most still received cancer treatment.
● Alternative clinical choices, such as the early utilization of hospice and palliative care, may improve quality of life and reduce the need for aggressive care for such patients.
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