{
  "abstract": "Objectives To examine differences in quality of dying (QOD) between patients with cancer receiving no anticancer treatment (untreated group) and those receiving chemotherapy in the last 3 months of life (late chemotherapy group), and to explore socioeconomic characteristics by treatment status.Methods This observational study used data from a Japanese nationwide mortality follow-back survey, restricted to cancer decedents. Questionnaires were mailed to their bereaved family members. The primary outcome was family-reported QOD, and the exploratory outcomes included symptom burden, end-of-life (EOL) discussions and socioeconomic factors. Analyses were stratified by age (<60, 60–79, ≥80 years).Results Of 48 124 eligible responses, 12 563 were untreated. The proportion untreated increased with age (4.9%<60 years, 42.4% ≥80 years). Untreated patients had shorter survival times and more hepatobiliary or pancreatic cancer. The QOD was not poorer in untreated patients. Of untreated patients <60 years, 42.9% were free from physical distress versus 28.9% in the late chemotherapy group (difference: 14.0 points; 95% CI 5.5 to 22.5). Among untreated patients aged 60–79 years, 51.0% reported life completion versus 41.7% in the late chemotherapy group (difference: 9.3 points; 95% CI 6.9 to 11.7). More families of untreated patients reported EOL discussions with their physicians. Younger, untreated patients were more likely to be from lower-income households.Conclusion The absence of anticancer treatment was not associated with a poorer QOD in untreated patients. Socioeconomic disparities among younger patients highlight the need for equitable access to cancer care and support for value-based EOL decision-making.",
  "authors": [
    {
      "affiliations": [
        "Division of Policy Evaluation, National Cancer Centre Institute for Cancer Control, Chuo, Tokyo, Japan"
      ],
      "name": "Yoko Nakazawa"
    },
    {
      "affiliations": [
        "Department of Palliative and Supportive Care, University of Tsukuba Institute of Medicine, Tsukuba, Ibaraki, Japan"
      ],
      "name": "Jun Hamano"
    },
    {
      "affiliations": [
        "Department of Palliative Nursing, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan"
      ],
      "name": "Mitsunori Miyashita"
    },
    {
      "affiliations": [
        "Department of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan",
        "Research Association for Community Health, Hamamatsu, Shizuoka, Japan"
      ],
      "name": "Tatsuya Morita"
    },
    {
      "affiliations": [
        "Department of Palliative and Supportive Care, University of Tsukuba Institute of Medicine, Tsukuba, Ibaraki, Japan"
      ],
      "name": "Yoshiyuki Kizawa"
    },
    {
      "affiliations": [
        "Initiative for Clinical Epidemiological Research, Machida, Tokyo, Japan"
      ],
      "name": "Yasuyuki Okumura"
    },
    {
      "affiliations": [
        "Aozora Clinic, Matsudo, Chiba, Japan"
      ],
      "name": "Shohei Kawagoe"
    },
    {
      "affiliations": [
        "Department of Respiratory Medicine, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Itabashi, Tokyo, Japan"
      ],
      "name": "Hiroshi Yamamoto"
    },
    {
      "affiliations": [
        "Division of Quality Assurance Programs, National Cancer Centre Institute for Cancer Control, Chuo, Tokyo, Japan"
      ],
      "name": "Emi Takeuchi"
    },
    {
      "affiliations": [
        "Department of Medical Psychology, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan"
      ],
      "name": "Risa Yamazaki"
    },
    {
      "affiliations": [
        "Department of Psycho-Oncology, National Cancer Centre Exploratory Oncology Research and Clinical Trial Centre Kashiwa Campus, Kashiwa, Chiba, Japan"
      ],
      "name": "Asao Ogawa"
    }
  ],
  "title": "Quality of death in cancer: no treatment versus late chemotherapy in a nationwide mortality follow-back study",
  "uid": "d77b135d-4f6b-5f9d-b1bd-91df8240a8c5"
}