Original Article| Volume 60, ISSUE 6, P1136-1143, December 2020

Download started.


Trends of Utilization of Palliative Care and Aggressive End-of-Life Care for Patients Who Died of Cancers and Those Who Died of Noncancer Diseases in Hospitals



      Patients who died of cancers and those who died of noncancer diseases may receive different end-of-life care.


      This study aimed to evaluate the trends of utilization of palliative care and aggressive end-of-life care for patients who died of cancers and those who died of noncancer diseases in hospitals.


      The medical records of patients who died in a public hospital because of cancer or other diseases were reviewed. The proportion of those who received palliative care, admitted to intensive care unit (ICU) within 30 days of death, died in ICU, and received cardiopulmonary resuscitation (CPR) within three days of death in 2013–2014, 2015–2016, and 2017–2018, respectively, was investigated. Multivariate logistic regression was applied to evaluate the independent effects of various factors on the risk of receiving aggressive end-of-life care.


      Significant trends of increase in receiving palliative care were found. The proportion of patients who died of noncancer diseases and received palliative care was lower than that of those who died of cancers. Palliative care was associated with a reduced risk of ICU admission within 30 days of death (adjusted odds ratio [AOR] 0.361), death in ICU (AOR 0.208), and receiving CPR within three days of death (AOR 0.057). Patients who died of noncancer diseases had a higher risk of ICU admission within 30 days of death (AOR 5.016), death in ICU (AOR 5.086), and receiving CPR within three days of death (AOR 3.274).


      Utilization of palliative care is increasing. Patients who died of noncancer diseases received less palliative care but more aggressive end-of-life care than those who died of cancers.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Pain and Symptom Management
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Zhang B.
        • Nilsson M.E.
        • Prigerson H.G.
        Factors important to patients' quality of life at the end of life.
        Arch Intern Med. 2012; 172: 1133-1142
        • Choi Y.
        • Park M.
        • Kang D.H.
        • et al.
        The quality of dying and death for patients in intensive care units: a single center pilot study.
        Crit Care Med. 2019; 34: 192-201
        • Su A.
        • Lief L.
        • Berlin D.
        • et al.
        Beyond pain: nurses' assessment of patient suffering, dignity, and dying in the intensive care unit.
        J Pain Symptom Manage. 2018; 55: 1591-1598
        • Wright A.A.
        • Keating N.L.
        • Balboni T.A.
        • et al.
        Place of death: correlations with quality of life of patients with cancer and predictors of bereaved caregivers' mental health.
        J Clin Oncol. 2010; 28: 4457-4464
        • Ko M.C.
        • Huang S.J.
        • Chen C.C.
        • et al.
        Factors predicting a home death among home palliative care recipients.
        Medicine (Baltimore). 2017; 96: e8210
        • Meaney P.A.
        • Nadkarni V.M.
        • Kern K.B.
        • et al.
        Rhythms and outcomes of adult in-hospital cardiac arrest.
        Crit Care Med. 2010; 38: 101-108
        • Perkins G.D.
        • Cooke M.W.
        Variability in cardiac arrest survival: the NHS ambulance service quality indicators.
        Emerg Med J. 2012; 29: 3-5
        • British Medical Association
        Decisions relating to cardiopulmonary resuscitation. A joint statement from the British Medical Association, the Resus-citation Council (UK) and the Royal College of Nursing.
        (Available from)
        • Earle C.C.
        • Neville B.A.
        • Landrum M.B.
        • et al.
        Evaluating claims-based indicators of the intensity of end-of-life cancer care.
        Int J Qual Health Care. 2005; 17: 505-509
        • Kang S.C.
        • Lin M.H.
        • Hwang I.H.
        • et al.
        Impact of hospice care on end-of-life hospitalization of elderly patients with lung cancer in Taiwan.
        J Chin Med Assoc. 2012; 75: 221-226
        • Stiel S.
        • Matthies D.M.
        • Seuss D.
        • et al.
        Symptoms and problem clusters in cancer and non-cancer patients in specialized palliative care—is there a difference?.
        J Pain Symptom Manage. 2014; 48: 26-35
        • Solano J.P.
        • Gomes B.
        • Higginson I.J.
        A comparison of symptom prevalence in far advanced cancer, AIDS, heart disease, chronic obstructive pulmonary disease and renal disease.
        J Pain Symptom Manage. 2006; 31: 58-69
        • Shih T.C.
        • Chang H.T.
        • Lin M.H.
        • et al.
        Differences in do-not-resuscitate orders, hospice care utilization, and late referral to hospice care between cancer and non-cancer decedents in a tertiary hospital in Taiwan between 2010 and 2015: a hospital-based observational study.
        BMC Palliat Care. 2018; 17: 18
        • Huang S.J.
        • Huang C.Y.
        • Woung L.C.
        • et al.
        The 2017 Taipei declaration for health-promoting palliative care.
        J Palliat Med. 2018; 21: 581-582
        • Cheng C.L.
        • Lee C.H.
        • Chen P.S.
        • et al.
        Validation of acute myocardial infarction cases in the national health insurance research database in Taiwan.
        J Epidemiol. 2014; 24: 500-507
        • Chiang J.K.
        • Lee Y.C.
        • Kao Y.H.
        Trend analysis of end-of-life care between hospice and non-hospice groups of cancer patients in Taiwan for 2002-11.
        Medicine (Baltimore). 2017; 96: e7825
        • Chang H.T.
        • Lin M.H.
        • Chen C.K.
        • et al.
        Trends of do-not resuscitate consent and hospice care utilization among noncancer decedents in a tertiary hospital in Taiwan between 2010 and 2014: a hospital-based observational study.
        Medicine. 2016; 95: e5394
        • Hwang J.
        • Shen J.
        • Kim S.J.
        • et al.
        Ten-year trends of utilization of palliative care services and life-sustaining treatments and hospital costs associated with patients with terminally ill lung cancer in the United States from 2005 to 2014.
        Am J Hosp Palliat Care. 2019; 36: 1105-1113
        • Shen J.J.
        • Ko E.
        • Kim P.
        • et al.
        Life-sustaining procedures, palliative care consultation, and do-not resuscitate status in dying patients with COPD in US hospitals: 2010-2014.
        J Palliat Care. 2018; 33: 159-166
        • Tang S.T.
        • Chen M.L.
        • Huang E.W.
        • et al.
        Hospice utilization in Taiwan by cancer patients who died between 2000 and 2004.
        J Pain Symptom Manage. 2007; 33: 446-453
        • Lin Y.H.
        The influence from palliative care education on the knowledge and attitude of medical students: a medical school survey from 2007 to 2011.
        (Available from)
        • Shih T.C.
        • Chang H.T.
        • Lin M.H.
        • et al.
        Trends of do-not-resuscitate orders, hospice care utilization, and late referral to hospice care among cancer decedents in a tertiary hospital in Taiwan between 2008 and 2014: a hospital-based observational study.
        J Palliat Med. 2017; 20: 838-844
        • Temel J.S.
        • Greer J.A.
        • Muzikansky A.
        • et al.
        Early palliative care for patients with metastatic non-small-cell lung cancer.
        N Engl J Med. 2010; 363: 733-742
        • Kao Y.H.
        • Chiang J.K.
        Effect of hospice care on quality indicators of end-of-life care among patients with liver cancer: a national longitudinal population-based study in Taiwan 2000-2011.
        BMC Palliat Care. 2015; 14: 39
        • Koff G.
        • Vaid U.
        • Len E.
        • Crawford A.
        • Oxman D.A.
        Differences in utilization of life support and end-of-life care for medical ICU patients with versus without cancer.
        Crit Care Med. 2017; 45: e379-e383
        • Gawande A.
        Being mortal: Medicine and what matters in the end.
        1st ed. Metropolitan Books/Henry Holt and Company, New York2014
        • Dy S.M.
        • Bridges J.F.
        Improving end-of-life decision-making about resuscitation and intubation.
        J Gen Intern Med. 2015; 30: 1049-1050
        • Setoguchi S.
        • Glynn R.J.
        • Stedman M.
        • et al.
        Hospice, opiates, and acute care service use among the elderly before death from heart failure or cancer.
        Am Heart J. 2010; 160: 139-144
        • Fujimoto K.
        • Minami S.
        • Yamamoto S.
        • et al.
        Comparison of timing and decision-makers of do-not-resuscitate orders between thoracic cancer and non-cancer respiratory disease patients dying in a Japanese acute care hospital.
        Support Care Cancer. 2014; 22: 1485-1492
        • Cheung W.Y.
        • Schaefer K.
        • May C.W.
        • et al.
        Enrollment and events of hospice patients with heart failure vs. cancer.
        J Pain Symptom Manage. 2013; 45: 552-560
        • Cohen J.
        • Beernaert K.
        • Van den Block L.
        • et al.
        Differences in place of death between lung cancer and COPD patients: a 14-country study using death certificate data.
        NPJ Prim Care Respir Med. 2017; 27: 14
        • O'Connor T.L.
        • Ngamphaiboon N.
        • Groman A.
        • et al.
        Hospice utilization and end-of-life care in metastatic breast cancer patients at a comprehensive cancer center.
        J Palliat Med. 2015; 18: 50-55