Hospice and Palliative care

Biography

Biography: Eunju Park

Abstract

The purpose of this study was to evaluate the feasibility of an advance directive (AD) at the time of starting first-line palliative chemotherapy. We investigated the changes in emotional distress, quality of life (QoL), and attitudes toward anticancer treatments before and after the AD.  Patients with advanced cancer who had just started first-line palliative chemotherapy were prospectively enrolled between February 2014 and October 2016. We assessed the attitude toward chemotherapy, the Hospital Anxiety and Depression Scale (HADS), and the European Organization for the Research and Treatment of Cancer Quality of Life questionnaire (EORTC-QLQ) scores before conducting the AD, and subsequently performed the AD after the first cycle of chemotherapy. Follow-up evaluations using the same parameters were performed in the next cycle visit. During the study period, 104 patients started palliative chemotherapy. Among them, 41 patients were excluded, and the remaining 64 patients were recommended an AD. Among these 64 patients, 44 agreed to conducting the AD. Ultimately, 41 patients completed the AD and all data including follow-up, whereas three were excluded. There were no significant differences before and after the AD in terms of HADS and EORTC-QLQ scores. Attitudes regarding chemotherapy were also unchanged (P = 0.773). A total of 36 patients (82%) followed physician recommendations, with the exception of eight patients, who terminated chemotherapy due to refusal or loss to follow-up. Based on our results showing no significant changes in depression and anxiety scores, QoL, and attitudes toward anticancer treatments after the AD, early integration of the AD at the start of first-line palliative chemotherapy is recommended.