The understanding of terminal cancer and its relationship with attitudes toward end-of-life care issues

June Koo Lee, Young Ho Yun, Ah Reum An, Dae Seog Heo, Byeong Woo Park, Chi Heum Cho, Sung Kim, Dae Ho Lee, Soon Nam Lee, Eun Sook Lee, Jung Hun Kang, Si Young Kim, Jung Lim Lee, Chang Geol Lee, Yeun Keun Lim, Samyong Kim, Jong Soo Choi, Hyun Sik Jeong, Mison Chun

Research output: Contribution to journalArticlepeer-review

10 Citations (Scopus)


Background. Although terminal cancer is a widely used term, its meaning varies, which may lead to different attitudes toward end-of-life issues. The study was conducted to investigate differences in the understanding of terminal cancer and determine the relationship between this understanding and attitudes toward end-of-life issues. Methods. A questionnaire survey was performed between 2008 and 2009. A total of 1242 cancer patients, 1289 family caregivers, 303 oncologists from 17 hospitals, and 1006 participants from the general population responded. Results. A "6-month life expectancy" was the most common understanding of terminal cancer (45.6%), followed by "treatment refractoriness" (21.1%), "metastatic/recurrent disease" (19.4%), "survival of a few days/weeks" (11.4%), and "locally advanced disease" (2.5%). The combined proportion of "treatment refractoriness" and "6-month life expectancy" differed significantly between oncologists and the other groups combined (76.0% v. 65.9%, P = 0.0003). Multivariate analyses showed that patients and caregivers who understood terminal cancer as "survival of a few days/ weeks" showed more negative attitudes toward disclosure of terminal status compared with participants who chose "treatment refractoriness" (adjusted odds ratio [aOR] 0.42, 95% confidence interval [CI] 0.22-0.79 for patients; aOR 0.34, 95% CI 0.18-0.63 for caregivers). Caregivers who understood terminal cancer as "locally advanced" or "metastatic/ recurrent disease" showed a significantly lower percentage of agreement with withdrawal of futile lifesustaining treatment compared with those who chose "treatment refractoriness" (aOR 0.19, 95% CI 0.07-0.54 for locally advanced; aOR 0.39, 95% CI 0.21-0.72 for metastatic/recurrent). Conclusions. The understanding of terminal cancer varied among the 4 participant groups. It was associated with different preferences regarding end-of-life issues. Standardization of these terms is needed to better understand end-of-life care.

Original languageEnglish
Pages (from-to)720-730
Number of pages11
JournalMedical Decision Making
Issue number6
Publication statusPublished - 2014 Aug

Bibliographical note

Funding Information:
This work was supported by the 2008 Korean National Cancer Control Program by the Ministry for Health, Welfare and Family Affairs, Korea. Financial support for this study was provided in part by a grant from the Ministry for Health, Welfare and Family Affairs, Korea. The funding agreement ensured the authors’ independence in designing the study, interpreting the data, and writing and publishing the report. The final data of this article were presented as a poster (#1854) at the palliative care session of ESMO 2012 congress (Vienna, Austria, 28 September to 2 October 2012).

All Science Journal Classification (ASJC) codes

  • Health Policy


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