Korean Journal of Family Medicine

"End-of-Life Care"

Original Articles

Low serum creatinine as well as high serum creatinine is associated with prognosis of patients with cancer in end-of-life: Yoo Jeong Lee, Soon-Young Hwang, Su Hyun Kim, Youn Seon Choi; Korean J Fam Med 2025;46(2):70-76. Published online October 27, 2023; DOI: https://doi.org/10.4082/kjfm.23.0116

Abstract
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Background
The prognosis of end-of-life patients is challenging, and clinicians have attempted to predict survival more accurately. High serum creatinine (sCr) levels are associated with lower survival rates in patients with various cancers; however, low sCr levels are commonly expected in patients with terminal cancer because of muscle wasting and malnutrition. Therefore, we investigated the prevalence of low and high sCr levels and their association with survival duration in patients with terminal cancer in a palliative care unit.
Methods
We analyzed the medical records of 280 patients admitted to a palliative care unit. Patients were divided into low (<0.5 mg/dL), normal (0.5–1.2 mg/dL), and high (>1.2 mg/dL) sCr groups. Kaplan-Meier survival curves using sCr levels were plotted and compared using the log-rank test. Using stepwise selection, a multivariable Cox proportional hazards model was used to identify the significant prognostic factors.
Results
The median survival durations in the high-, low-, and normal-sCr groups were 9.57 days, 22.26 days, and 27.51 days, respectively. Multivariable Cox proportional hazard model identified that males (hazard ratio [HR], 1.81; 95% confidence interval [CI], 1.16–2.85), poor performance status (HR, 3.43; 95% CI, 1.12–10.54), total parenteral nutrition use (HR, 1.84; 95% CI, 1.09–3.1), high sCr (HR, 2.74; 95% CI, 1.52–4.94), and low sCr (HR, 1.22; 95% CI, 1.07–1.43) were significantly associated with a shorter survival time.
Conclusion
Low and high serum creatinine levels were significantly associated with poor survival in patients with cancer at the end-of-life stage. Therefore, readily available and simple biomarkers may help plan advanced care in palliative care settings.

Citations

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COPD Severity as an Independent Predictor of Long-Term Survival in Operable Lung Cancer: A Retrospective Analysis from a High-Volume Thoracic Surgery Center
Julia Zimmermann, Johannes Schön, Valentina Pfeiffer, Tim-Mathis Beutel, Annalena Felker, Elvira Stacher-Priehse, Fuad Damirov, Niels Reinmuth, Rudolf Hatz, Christian Schneider, Mircea Stoleriu
International Journal of Chronic Obstructive Pulmonary Disease.2025; Volume 20: 3073. CrossRef

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The Realities and Associated Factors of Palliative Chemotherapy Near the End of Life in the Patients Enrolled in Palliative Care Unit: Daeun Jung, Sunjin Hwang, Hyun Jung You, Jungkwon Lee; Korean J Fam Med 2012;33(1):44-50. Published online January 31, 2012; DOI: https://doi.org/10.4082/kjfm.2012.33.1.44

Abstract
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Background

It is important to know and decide when to end regimen for the quality of life of the patients. However, there is currently no clear agreement on when to terminate palliative chemotherapy. We investigated the duration between the last chemotherapy and death, and associated factors affecting patients receiving palliative care after the last chemotherapy.

Methods

We studied 242 patients who were put into palliative care ward after receiving chemotherapy and died during hospitalization from 2008 to 2009. Electronic medical records were used to gather information on demographic characteristics, types of primary cancer, and palliative chemotherapy. Then we analyzed the relationship between the clinical characteristics of patients and interval between last chemotherapy and death.

Results

The average survival time of patients after referral to palliative care was 17.5 days; survival time after discontinuation of chemotherapy was 103 days. Also, 104 (43.0%) patients died within 3 months and 14 (5.8%) patients died within 1 month of persistent palliative chemotherapy. Chemotherapy on patients within 3 months from their death was not associated with the social characteristics of the population.

Conclusion

The patients who were referred to palliative care were found to have continued to receive chemotherapy within 3 months before death. However, only a small number of patients received chemotherapy within 1 month before death, which confirms that futile chemotherapy that extends to the end of life was less frequent. Doctors should be able to recognize the implications of excessive and aggressive use of chemotherapy and should actively communicate with patients about therapeutic choices.

Citations

Citations to this article as recorded by

Palliative chemotherapy for breast cancer: A population‐based cohort study of emergency hospital admissions and place of death
Chloe J. Bright, Casey Dunlop, Cong Chen, Rebecca Smittenaar, Sean McPhail, Georgina Hanbury, David Dodwell, Kathy Pritchard‐Jones, Mick Peake, Emma Kipps
European Journal of Cancer Care.2022;[Epub] CrossRef