Trends in the Aggressiveness of End-of-Life Care for Korean Pediatric Cancer Patients Who Died in 2007-2010

Background: In light of the Korean Supreme Court's 2009 ruling favoring a patient's right to die with dignity, we evaluated trends in aggressive care in a cohort of pediatric cancer patients. Methods We conducted a population-based retrospective study that used administrative data for patients who died in 2007-2010 among the 5,203 pediatric cancer patients registered at the Korean Cancer Central Registry (KCCR) during 2007-2009. Results: In the time period covered, 696 patients died. The proportion who had received chemotherapy in the last 30 days of life decreased from 58.1% to 28.9% (P<0.001), those who received new chemotherapy in the same time period decreased from 55.2% to 15.1% (P<0.001), and those who received treatment in the last 2 weeks of life decreased from 51.4% to 21.7% (P<0.001). In the last 30 days of life, the proportion of patients whose hospital admission period was over 14 days increased from 70.5% to 82.5% (P = 0.03), the proportion who received cardiopulmonary resuscitation decreased from 28.6% to 9.6% (P<0.001), and we found no statistically significant trends in the proportion of emergency department visits, intensive care unit admissions, or mechanical ventilation. Conclusions: In this study, in contrast with earlier ones, the aggressiveness of end-of-life care of Korean pediatric cancer patients decreased dramatically.