Age‐Related Differences in Decision‐Making Roles and End‐of‐Life Care Trajectories Among Adults With Cancer
Sun Young Lee, Jin‐ah Sim, Wantaek Lee, Hak Jun Kim, Shin Hye YooABSTRACT
Background
As populations age, older adults represent a growing proportion of patients with cancer nearing the end of life. However, age‐related differences in treatment decision‐making and patterns of end‐of‐life care in routine cancer practice remain insufficiently described.
Methods
We conducted a retrospective cohort study of adults with cancer who received palliative care consultations at a tertiary hospital in Korea between 2018 and 2022. Clinical data were linked with national health insurance claims. Patients were categorized into five age groups (18–44, 45–64, 65–74, 75–84, and ≥ 85 years), and age‐related differences in referral timing, decision‐making roles, and end‐of‐life care patterns were examined.
Results
Among 6151 patients, 54.3% were aged ≥ 65 years, including 3.3% who were aged ≥ 85 years. Older patients were referred earlier. Advance statements were completed by 59.2% overall, with the lowest completion (52.2%) and fewer patient‐determined decisions to withhold or withdraw life‐sustaining treatment (62.0%) in the oldest group. Intensive care unit admission rates were similar across age groups, while cardiopulmonary resuscitation and ventilation were less frequent among patients aged ≥ 85 years. Hospice use declined with age. Total medical costs during the last 6 months of life decreased with age yet remained considerable among older patients. Most deaths occurred in tertiary hospitals (26.9%–31.9%), while deaths in nursing care facilities increased with advancing age.
Conclusions
Although older adults were referred earlier to palliative care, they were less likely to make their own treatment decisions, and aggressive care remained common. These findings indicate a need for age‐sensitive approaches to improve end‐of‐life care.