{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T06:25:10Z","timestamp":1787034310285,"version":"build-2736575974"},"reference-count":50,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T00:00:00Z","timestamp":1787011200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100008746","name":"National Cancer Center","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100008746","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Timely hospice initiation may reduce aggressive end-of-life (EOL) care, but studies on this topic are limited. This study investigated the association between time-to-hospice use and aggressive care utilization at EOL in terminally ill patients with cancer.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Using linked K-CURE claims and cancer registry data, this retrospective cohort study in South Korea included cancer patients who received hospice care between 2015 and 2022. Hospice timing was defined as the interval between the last systemic anticancer therapy (SACT), including cytotoxic chemotherapy, hormonal\/endocrine therapy, targeted therapy, and immunotherapy, and the first use of hospice care. The interval was categorized as \u2264 30 days, 31\u201360 days, 61\u201390 days, and &amp;gt;90 days. Aggressive care outcomes included intensive care unit (ICU) admission, emergency department (ED) visits \u22652 times, and a composite measure of these outcomes occurring before hospice initiation. Multivariable logistic regression analyses were conducted, adjusting for sociodemographic and clinical variables.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 37,996 hospice users, 54.7% initiated hospice care more than 30 days after their last SACT, and this proportion exceeded 50% throughout most of the study period. The proportion initiating hospice care &amp;gt;90 days after the last SACT increased over time (annual percentage change, 8.2%;\n                      <jats:italic>p<\/jats:italic>\n                      for trend = 0.0001). ICU admission and ED visits \u22652 times before hospice initiation occurred in 3.4 and 16.4% of the patients, respectively. Compared with hospice initiation within 30 days after the last SACT, progressively higher odds of ICU admission, ED visits \u22652 times, and the composite outcome were observed with longer intervals: at 31\u201360 days (ORs, 3.515, 5.877, and 5.285, respectively), 61\u201390 days (ORs, 5.678, 13.610, and 11.806), and &amp;gt;90 days (ORs, 9.108, 31.127, and 25.174), indicating a clear dose-response relationship.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Delayed hospice initiation was associated with increased use of aggressive EOL care, supporting the need for timely transition to hospice care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1909398","type":"journal-article","created":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T05:36:31Z","timestamp":1787031391000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Timing of hospice care initiation and aggressive care utilization in patients with cancer: a retrospective nationwide study in Korea"],"prefix":"10.3389","volume":"14","author":[{"given":"Boram","family":"Kim","sequence":"first","affiliation":[{"name":"National Hospice Center, National Cancer Control Institute, National Cancer Center","place":["Goyang, Republic of Korea"]},{"name":"Department of Hospice and Palliative Service, National Cancer Center","place":["Goyang, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Woorim","family":"Kim","sequence":"additional","affiliation":[{"name":"Cancer Knowledge and Information Center, National Cancer Control Institute, National Cancer Center","place":["Goyang, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dae Hun","family":"Ryu","sequence":"additional","affiliation":[{"name":"National Hospice Center, National Cancer Control Institute, National Cancer Center","place":["Goyang, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jin Young","family":"Choi","sequence":"additional","affiliation":[{"name":"National Hospice Center, National Cancer Control Institute, National Cancer Center","place":["Goyang, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,18]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"e74666","DOI":"10.7759\/cureus.74666","article-title":"A disease of modern times?","volume":"16","author":"Nwosu","year":"2024","journal-title":"Cureus."},{"key":"B2","doi-asserted-by":"publisher","first-page":"e3327","DOI":"10.31661\/gmj.v13i.3327","article-title":"The impact of cancer on mental health and the importance of supportive services","volume":"13","author":"Fereidouni","year":"2024","journal-title":"Galen Med J."},{"key":"B3","doi-asserted-by":"publisher","first-page":"329","DOI":"10.1177\/0269216317734435","article-title":"What is the impact of population ageing on the future provision of end-of-life care? Population-based projections of place of death","volume":"32","author":"Bone","year":"2018","journal-title":"Palliat Med."},{"key":"B4","doi-asserted-by":"publisher","first-page":"372","DOI":"10.4037\/ajcc2018575","article-title":"Pilot study assessing the impact of bereavement support on families of deceased intensive care unit patients","volume":"27","author":"McAdam","year":"2018","journal-title":"Am J Crit Care."},{"key":"B5","doi-asserted-by":"publisher","first-page":"1144","DOI":"10.1002\/pon.5902","article-title":"Prolonged grief disorder and depression are distinguishable syndromes: a latent transition analysis for bereaved family caregivers of cancer patients","volume":"31","author":"Wen","year":"2022","journal-title":"Psychooncology."},{"key":"B6","doi-asserted-by":"publisher","first-page":"469","DOI":"10.1056\/NEJMoa063446","article-title":"A communication strategy and brochure for relatives of patients dying in the ICU","volume":"356","author":"Lautrette","year":"2007","journal-title":"N Engl J Med."},{"key":"B7","doi-asserted-by":"publisher","first-page":"63","DOI":"10.52937\/hira.24.4.1.e1","article-title":"Trends and status of hospice use in South Korea (2018\u20132022)","volume":"4","author":"Kim","year":"2024","journal-title":"HIRA Res."},{"key":"B8","unstructured":"Sejong\n          Ministry of Government Legislation; Korean Law Information Center\n          Act on Hospice and Palliative Care and Decisions on Life-Sustaining Treatment for Patients at the End of Life\n          \n          19466"},{"key":"B9","doi-asserted-by":"publisher","first-page":"99","DOI":"10.14475\/kjhpc.2016.19.2.99","article-title":"Hospice palliative care in South Korea: past, present, and future","volume":"19","author":"Kim","year":"2016","journal-title":"Korean J Hosp Palliat Care."},{"key":"B10","doi-asserted-by":"publisher","first-page":"1743","DOI":"10.1002\/cncr.28628","article-title":"Impact of timing and setting of palliative care referral on quality of end-of-life care in cancer patients","volume":"120","author":"Hui","year":"2014","journal-title":"Cancer."},{"key":"B11","doi-asserted-by":"publisher","first-page":"3860","DOI":"10.1200\/JCO.2007.15.8253","article-title":"Aggressiveness of cancer care near the end of life: is it a quality-of-care issue?","volume":"26","author":"Earle","year":"2008","journal-title":"J Clin Oncol."},{"key":"B12","doi-asserted-by":"publisher","first-page":"1133","DOI":"10.1200\/JCO.2003.03.059","article-title":"Identifying potential indicators of the quality of end-of-life cancer care from administrative data","volume":"21","author":"Earle","year":"2003","journal-title":"J Clin Oncol."},{"key":"B13","doi-asserted-by":"publisher","first-page":"318","DOI":"10.1634\/theoncologist.2016-0227","article-title":"Early palliative care reduces end-of-life intensive care unit use but not ICU course in patients with advanced cancer","volume":"22","author":"Romano","year":"2017","journal-title":"Oncologist."},{"key":"B14","doi-asserted-by":"publisher","first-page":"e2440977","DOI":"10.1001\/jamanetworkopen.2024.40977","article-title":"Timing of palliative care, end-of-life quality indicators, and health resource utilization","volume":"7","author":"Mah","year":"2024","journal-title":"JAMA Netw Open."},{"key":"B15","doi-asserted-by":"publisher","first-page":"e2440902","DOI":"10.1001\/jamanetworkopen.2024.40902","article-title":"Timing of palliative care initiation and resource use\u2014are we any further ahead?","volume":"7","author":"Hsieh","year":"2024","journal-title":"JAMA Netw Open."},{"key":"B16","doi-asserted-by":"publisher","first-page":"1665","DOI":"10.1001\/jama.300.14.1665","article-title":"Associations between end-of-life discussions, patient mental health, medical care near death, and caregiver bereavement adjustment","volume":"300","author":"Wright","year":"2008","journal-title":"JAMA."},{"key":"B17","doi-asserted-by":"publisher","first-page":"4457","DOI":"10.1200\/JCO.2009.26.3863","article-title":"Place of death: correlations with quality of life of patients with cancer and predictors of bereaved caregivers' mental health","volume":"28","author":"Wright","year":"2010","journal-title":"J Clin Oncol."},{"key":"B18","doi-asserted-by":"publisher","first-page":"88","DOI":"10.1001\/jama.291.1.88","article-title":"Family perspectives on end-of-life care at the last place of care","volume":"291","author":"Teno","year":"2004","journal-title":"JAMA."},{"key":"B19","doi-asserted-by":"publisher","first-page":"565","DOI":"10.1111\/j.1475-6773.2010.01082.x","article-title":"Long-term trends in Medicare payments in the last year of life","volume":"45","author":"Riley","year":"2010","journal-title":"Health Serv Res."},{"key":"B20","doi-asserted-by":"publisher","first-page":"1584","DOI":"10.1200\/JCO.2002.20.6.1584","article-title":"Time spent in hospital in the last six months of life in patients who died of cancer in Ontario","volume":"20","author":"Huang","year":"2002","journal-title":"J Clin Oncol."},{"key":"B21","doi-asserted-by":"publisher","first-page":"733","DOI":"10.1056\/NEJMoa1000678","article-title":"Early palliative care for patients with metastatic non-small-cell lung cancer","volume":"363","author":"Temel","year":"2010","journal-title":"N Engl J Med."},{"key":"B22","doi-asserted-by":"publisher","first-page":"312","DOI":"10.4143\/crt.2025.264","article-title":"Cancer statistics in Korea: incidence, mortality, survival, and prevalence in 2022","volume":"57","author":"Park","year":"2025","journal-title":"Cancer Res Treat."},{"key":"B23","year":""},{"key":"B24","doi-asserted-by":"publisher","first-page":"e0123764","DOI":"10.1371\/journal.pone.0123764","article-title":"Measuring intensity of end of life care: a systematic review","volume":"10","author":"Luta","year":"2015","journal-title":"PLoS ONE."},{"key":"B25","doi-asserted-by":"publisher","first-page":"1014","DOI":"10.4143\/crt.2024.207","article-title":"Data resource profile: the cancer public library database in South Korea","volume":"56","author":"Choi","year":"2024","journal-title":"Cancer Res Treat."},{"key":"B26","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1186\/s12904-018-0300-x","article-title":"Effects of a new medical insurance payment system for hospice patients in palliative care programs in Korea","volume":"17","author":"Lee","year":"2018","journal-title":"BMC Palliat Care."},{"key":"B27","doi-asserted-by":"publisher","first-page":"689","DOI":"10.4236\/health.2015.76082","article-title":"Hospice and palliative care services in South Korea supported by the National Health Insurance (NHI) program","volume":"7","author":"Rhee","year":"2015","journal-title":"Health."},{"key":"B28","doi-asserted-by":"publisher","first-page":"8","DOI":"10.14475\/kjhpc.2017.20.1.8","article-title":"Hospice and palliative care policy in Korea","volume":"20","author":"Kim","year":"2017","journal-title":"J Hosp Palliat Care."},{"key":"B29","doi-asserted-by":"publisher","first-page":"505","DOI":"10.1093\/intqhc\/mzi061","article-title":"Evaluating claims-based indicators of the intensity of end-of-life cancer care","volume":"17","author":"Earle","year":"2005","journal-title":"Int J Qual Health Care."},{"key":"B30","doi-asserted-by":"publisher","first-page":"142","DOI":"10.1001\/jamaoncol.2019.3388","article-title":"Population-based quality indicators for end-of-life cancer care","volume":"6","author":"Henson","year":"2020","journal-title":"JAMA Oncol."},{"key":"B31","doi-asserted-by":"publisher","first-page":"284","DOI":"10.1001\/jama.2015.18604","article-title":"Family perspectives on aggressive cancer care near the end of life","volume":"315","author":"Wright","year":"2016","journal-title":"JAMA."},{"key":"B32","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1186\/s12904-022-00988-3","article-title":"Aggressiveness of care in the last days of life in the emergency department of a tertiary hospital in Korea","volume":"21","author":"Kim","year":"2022","journal-title":"BMC Palliat Care."},{"key":"B33","doi-asserted-by":"publisher","first-page":"1130","DOI":"10.1097\/01.mlr.0000182534.19832.83","article-title":"Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data","volume":"43","author":"Quan","year":"2005","journal-title":"Med Care."},{"key":"B34","doi-asserted-by":"publisher","first-page":"1288","DOI":"10.1016\/j.jclinepi.2004.03.012","article-title":"New ICD-10 version of the Charlson comorbidity index predicted in-hospital mortality","volume":"57","author":"Sundararajan","year":"2004","journal-title":"J Clin Epidemiol."},{"key":"B35","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1186\/s12963-018-0173-5","article-title":"Quantifying temporal trends of age-standardized rates with odds","volume":"16","author":"Tan","year":"2018","journal-title":"Popul Health Metrics."},{"key":"B36","doi-asserted-by":"publisher","first-page":"1","DOI":"10.4143\/crt.2013.148","article-title":"Patient's factors at entering hospice affecting length of survival in a hospice center","volume":"47","author":"Lee","year":"2015","journal-title":"Cancer Res Treat."},{"key":"B37","doi-asserted-by":"publisher","first-page":"368","DOI":"10.1186\/s12916-020-01829-x","article-title":"Duration of palliative care before death in international routine practice: a systematic review and meta-analysis","volume":"18","author":"Jordan","year":"2020","journal-title":"BMC Med."},{"key":"B38","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1186\/s12904-020-00556-7","article-title":"Palliative care utilization in oncology and hemato-oncology: a systematic review of cognitive barriers and facilitators from the perspective of healthcare professionals, adult patients, and their families","volume":"19","author":"Bennardi","year":"2020","journal-title":"BMC Palliat Care."},{"key":"B39","doi-asserted-by":"publisher","first-page":"1927","DOI":"10.1007\/s00520-018-4457-x","article-title":"The earlier the better: the role of palliative care consultation on aggressive end of life care, hospice utilization, and advance care planning documentation among gynecologic oncology patients","volume":"27","author":"Schneiter","year":"2019","journal-title":"Support Care Cancer."},{"key":"B40","doi-asserted-by":"publisher","first-page":"102561","DOI":"10.1016\/j.eclinm.2024.102561","article-title":"Prevalence of aggressive care among patients with cancer near the end of life: a systematic review and meta-analysis","volume":"71","author":"Ma","year":"2024","journal-title":"EClinicalMedicine."},{"key":"B41","doi-asserted-by":"publisher","first-page":"252","DOI":"10.14475\/kjhpc.2020.23.4.252","article-title":"Barriers to early palliative care","volume":"23","author":"Yoon","year":"2020","journal-title":"Korean J Hosp Palliat Care."},{"key":"B42","doi-asserted-by":"publisher","first-page":"138","DOI":"10.14475\/jhpc.2025.28.4.138","article-title":"Hospice and palliative care response policy during the coronavirus disease 2019 (COVID-19) pandemic in South Korea","volume":"28","author":"Kim","year":"2025","journal-title":"J Hosp Palliat Care."},{"key":"B43","doi-asserted-by":"publisher","first-page":"160","DOI":"10.1186\/s12904-024-01459-7","article-title":"Decreased aggressive care at the end of life among advanced cancer patients in the Republic of Korea: a nationwide study from 2012 to 2018","volume":"23","author":"Kwon","year":"2024","journal-title":"BMC Palliat Care."},{"key":"B44","doi-asserted-by":"publisher","first-page":"e0269565","DOI":"10.1371\/journal.pone.0269565","article-title":"Healthcare resource utilization and medical costs in patients with terminal cancer during best supportive care","volume":"17","author":"Kang","year":"2022","journal-title":"PLoS ONE."},{"key":"B45","doi-asserted-by":"publisher","first-page":"e230394","DOI":"10.1001\/jamanetworkopen.2023.0394","article-title":"Incidence of aggressive end-of-life care among older adults with metastatic cancer living in nursing homes and community settings","volume":"6","author":"Koroukian","year":"2023","journal-title":"JAMA Netw Open."},{"key":"B46","doi-asserted-by":"publisher","first-page":"439","DOI":"10.21037\/apm-25-56","article-title":"Factors associated with aggressive care at the end of life for patients with gastrointestinal cancer","volume":"14","author":"Kadono","year":"2025","journal-title":"Ann Palliat Med."},{"key":"B47","doi-asserted-by":"publisher","first-page":"908","DOI":"10.4143\/crt.2021.325","article-title":"Life-sustaining treatment states in Korean cancer patients after enforcement of act on decisions on life-sustaining treatment for patients at the end of life","volume":"53","author":"Won","year":"2021","journal-title":"Cancer Res Treat."},{"key":"B48","doi-asserted-by":"publisher","first-page":"752","DOI":"10.1007\/s00520-026-10916-3","article-title":"Association between the timing of palliative care consultation and end-of-life outcomes in patients with cancer","volume":"34","author":"Kim","year":"2026","journal-title":"Support Care Cancer."},{"key":"B49","doi-asserted-by":"publisher","first-page":"111","DOI":"10.1186\/s12904-024-01442-2","article-title":"Differences in end-of-life care patterns between types of hospice used for cancer patients: a retrospective cohort study","volume":"23","author":"Yun","year":"2024","journal-title":"BMC Palliat Care."},{"key":"B50","doi-asserted-by":"publisher","first-page":"101774","DOI":"10.1016\/j.jgo.2024.101774","article-title":"Predictors of high-intensity care at the end of life among older adults with solid tumors: a population-based study","volume":"15","author":"Baird","year":"2024","journal-title":"J Geriatr Oncol."}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1909398\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T05:36:33Z","timestamp":1787031393000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1909398\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,18]]},"references-count":50,"alternative-id":["10.3389\/fpubh.2026.1909398"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2026.1909398","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,18]]},"article-number":"1909398"}}