Background
: Two representative groups of family physicians and oncologists were surveyed concerning their knowledge and attitudes toward cancer pain management (CPM).

Methods : A questionnaire, designed to assess knowledge (13 items) and attitudes (6 items) toward CPM, was sent to 2,200 members of Korean Association of Family Medicine and 800 members of Korean Cancer Association.

Results : Three hundred and eighty eight family physicians (17.6%) and one hundred and forty seven oncologists (18.4%) responded and completed the questionnaire. They had inadequate knowledge toward CPM, especially, chance of respiratory depression, tolerance to adverse effect, ceiling effect, risk of addiction, and use of adjuvants. Most of the physicians had positive attitude toward importance of CPM, best judge of pain severity, and priority of CPM but had negative attitude toward concerns about potential problem of addiction and earlier prescription of maximum dose of opioid. Family physicians displayed more lack of knowledge about CPM in 9 of 13 items and more negative attitudes toward 4 of 6 items. Adjustment for demographic characteristics and experiences in cancer patients with pain showed that while family physicians had poor knowledge of tolerance to confusion, they had more adequate knowledge on the effect of antidepressant and had positive attitude towards best judge of pain severity and priority of CPM. Poor knowledge about CPM was rated by 66.3% of physicians as the most important barrier to adequate CPM.

Conclusion : These findings that most of the physicians had poor knowledge and negative view toward CPM suggest a continuous need for comprehensive education program focused on CPM for physicians.

Background
: Many terminal cancer patients and families are affected with physical, emotional, and social problems. Many people claim that a type of medical services is needed to manage them such as hospice·palliative care. There have not been many studies of cancer patients and families with respect to their opinions and attitudes on hospice·palliative care for terminal cancer patients, although their views on it is important.

Methods : We surveyed 687 in-patients, out-patients and their families with cancer in 8 hospitals. The self-administered questionnaires included the following; 1) socio-demographic and clinical variables; 2) opinions on hospice·palliative care; 3) attitudes on ethical issues associated with hospice·palliative care; 4) factors associated with withholding futile care at the end-of-life. The data were analyzed with x²-test, Mantel-Haenszel x²-test, and multiple logistic regression.

Results : Almost 90% of the subjects agreed to the need of obtaining hospice·palliative care with health care insurances and reaching a social consensus on the contents of its programs. Five hundred and seventy six (83.8%) subjects agreed to the need of using advanced directives. Two hundred and eighty five (72.2%) cancer patients and 200 (68.5%) families agreed to the need of withholding futile care at the end-of-life and of people accepting their cancer diagnosis with insight and living in the metropolis as they were more likely to do. In the multivariate analysis, the attitudes on withholding futile care at the end-of-life was significantly different only by insight of cancer diagnosis (OR; 1.09∼3.15).

Conclusion : This study showed that hospice·palliative care should be established through social consensus on the issues related to ethics and insurances, and that cancer patients and families must have a right to choose such services with informed decision-making.

Background
: Life expectancy is ever increasing due to medical advancements, but cancer death rate is also increased. Quality of life is an important issue in cancer patients. Despite developments of early diagnosis and treatments for cancer, the medical costs is increasing due to extended survival against cancer and the absolute numbers of terminal cancer patients. We assessed the medical costs and quality of life in terminal cancer patients by the types of medical facilities, which would contribute to effective management.
Method: A total 159 patients (males 70, females 89) with terminal cancer patients who were treated and died in various types of medical facilities(home hospice, charity hospital hospice unit, university hospital hospice unit, university hospital non-hospice unit) between November 1, 1997 and January 31, 1999 were included in the study. After the confirmation that the demographic factors correlated with factors of quality of life, the differences in the medical costs and quality of life(pain, depression, ADLs, family APGAR score) during the last 1 week of life in the various types of medical facilities analyzed by multi-way ANOVA with interaction of the significant demographic factors.

Results : The mean cost of types of medical facilities during the last week of patients as 65,332.5 won in charity hospital hospice unit, 105,165.5 won in home hospice, 702,083.4 won in university hospital hospice unit, and 1,037,358.6 won in university hospital non-hospice unit. The difference between free hospital hospice unit and home hospice in medical costs as not statistically significant, but the difference among charity hospital hospice unit and home hospice, university hospital hospice unit, and university hospital non-hospice unit as significant (p<0.001). The demographical factors of quality of life in terms of pain, depression, ADLs, and family APGAR score were compared among various facilities. The ADL score of home hospice was 8.2±3.3, which was lower than free hospital hospice unit and university hospital hospice unit(p<0.05). The mean pain score of home hospice as 1.7±1.7 and that of university hospital hospice as 1.2±1.2, and pain scores of home hospice were lower than free hospital hospice unit, and pain scores of university hospital hospice were lower than free hospital hospice unit and university hospital non-hospice unit(p<0.05). In depressions categorical scale of home hospice the score was 4.8±1.3, which was higher than those of free hospital hospice unit and university hospital non-hispice unit(p<0.05), signifying less depression. The family APGAR score was statistically insignificant among various types of medical facilities.

Conclusion : The cost of hospice care is less than the non-hospice care. We found that the patients of home hospice experienced less pain and depression even with low ADLs, and increased the quality of life in both psychological and physical aspects.