End-of-Life Care for Chronic Hemodialysis Patients with Terminal Cancer

Abstract

The primary aim of this study was to see the choice of the place of death by the chronic hemodialysis patients with terminal cancer. Chronic hemodialysis patients diagnosed with advanced cancer who had palliative care service between May 2007 and September 2016, both inpatient and outpatient, were extracted from the database of palliative patients in a university hospital. Retrospective survey assessed characteristics of the patients including dialysis history, place of death, survival days after stopping dialysis. A total of 26 patients were surveyed. Compared with non-dialyzed patients, they were significantly old (61.6±14.7 vs 70.0±8.1 years old, p<0.001). 76.9% (20 of 26) patients had first contacts with palliative services after discontinuation of chemotherapy. 21 patients died; 10 at non-palliative care unit in the hospital, 6 in other hospitals without palliative care service, 4 at palliative care unit and 1 at home with palliative care service. Patients who died with less palliative services had significantly longer dialysis history than those who died in palliative care units and at home with palliative care services (11.5±10.4 vs 2.2±1.1 years, p<0.001). Patients who spent final days in the palliative care unit had relatively longer survival without dialysis than those who died in non-palliative ward in the same hospital (9.3 days vs 3.1 days, p=0.16). Chronic dialysis patients with terminal cancer who had longer dialysis history chose to continue dialysis therapy until just before death without good palliative service.