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Abstract
Background: Both life expectancy and rates of cancer death increase in Korea, and quality of life is increasingly recognised as an important issue for cancer patients. Despite the developments of early diagnosis and treatments for cancer, increased medical costs have became a major problem for families and for governments. This study assessed the medical costs and the quality of life in terminal cancer patients in various care facilities to assess the contribution of hospice care to the maintenance of quality of life and to cost reduction.
Methods: A total of 159 patients (male: 70, female: 89) with terminal cancer were entered into the study. Their care was managed in four types of care facility (home hospice, charity hospital hospice unit, university hospital hospice unit, university hospital non-hospice unit) between November 1 1997 and January 31 1999. Differences in medical costs and quality of life (pain, depression, ADLs, family APGAR score) were assessed during the last 1 week of life in these facilities, analysed by one-way ANOVA test.
Results: Mean costs of the medical care during the last week of life was US$ 54.4 in the charity hospital hospice unit, US$ 87.6 in the home hospice, US$ 585.1 in the university hospital hospice unit, and US$ 864.5 in the university hospital non-hospice unit. ADL scores for patient in the home hospice were lower than those of other medical facilities (p<0.001). Pain scores on the dying day and one day before death were lowest in the home hospice and university hospital hospice (p<0.01). No differences were noted in depression scales or family APGAR scores.
Conclusion: In Korea, where much charitable and volunteer effort maintains hospice programmes, the cost of hospice care is less than that of the non-hospice care. Patients of home hospice, even with low ADLs, experienced less pain and had measures of psychological and family functioning score during the last days of life no less than in other settings. Hospice approaches to care deserve greater recognition and official support in Korea.