Age‐Related Differences in Decision‐Making Roles and End‐of‐Life Care Trajectories Among Adults With Cancer
6 affiliations
- 1Public Healthcare Center Seoul National University Hospital Seoul South Korea
- 2Department of Human Systems Medicine Seoul National University College of Medicine Seoul South Korea
- 3Graduate School of Public Health and Healthcare Management The Catholic University of Korea Seoul South Korea
- 4Department of Population and Quantitative Health Sciences UMass Chan Medical School Worcester Massachusetts USA
- 5Department of Artificial Intelligence Convergence Hallym University Chuncheon South Korea
- 6Center for Palliative Care and Clinical Ethics Seoul National University Hospital Seoul South Korea
Abstract
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.
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BibTeX
@article{lee2026agerelated,
title = {{Age‐Related Differences in Decision‐Making Roles and End‐of‐Life Care Trajectories Among Adults With Cancer}},
author = {Sun Young Lee and Jin‐ah Sim and Wantaek Lee and Hak Jun Kim and Shin Hye Yoo},
journal = {Cancer Medicine},
year = {2026},
month = oct,
doi = {10.1002/cam4.72444},
url = {https://doi.org/10.1002/cam4.72444},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Age‐Related Differences in Decision‐Making Roles and End‐of‐Life Care Trajectories Among Adults With Cancer
AU - Sun Young Lee
AU - Jin‐ah Sim
AU - Wantaek Lee
AU - Hak Jun Kim
AU - Shin Hye Yoo
PY - 2026
DA - 2026/10/27
JO - Cancer Medicine
DO - 10.1002/cam4.72444
UR - https://doi.org/10.1002/cam4.72444
AB - 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.
SN - 2045-7634
ER -