Age-Related Differences in Decision-Making Roles and End-of-Life Care Trajectories Among Adults With Cancer.
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BACKGROUND: As populations age, older adults represent a growing proportion of patients with cancer nearing the end of life. However, age-related differences in treatment decision-making and patterns of end-of-life care in routine cancer practice remain insufficiently described. METHODS: We conducted a retrospective cohort study of adults with cancer who received palliative care consultations at a tertiary hospital in Korea between 2018 and 2022. Clinical data were linked with national health insurance claims. Patients were categorized into five age groups (18-44, 45-64, 65-74, 75-84, and ≥ 85 years), and age-related differences in referral timing, decision-making roles, and end-of-life care patterns were examined. RESULTS: Among 6151 patients, 54.3% were aged ≥ 65 years, including 3.3% who were aged ≥ 85 years. Older patients were referred earlier. Advance statements were completed by 59.2% overall, with the lowest completion (52.2%) and fewer patient-determined decisions to withhold or withdraw life-sustaining treatment (62.0%) in the oldest group. Intensive care unit admission rates were similar across age groups, while cardiopulmonary resuscitation and ventilation were less frequent among patients aged ≥ 85 years. Hospice use declined with age. Total medical costs during the last 6 months of life decreased with age yet remained considerable among older patients. Most deaths occurred in tertiary hospitals (26.9%-31.9%), while deaths in nursing care facilities increased with advancing age. CONCLUSIONS: Although older adults were referred earlier to palliative care, they were less likely to make their own treatment decisions, and aggressive care remained common. These findings indicate a need for age-sensitive approaches to improve end-of-life care.