Comparison of Broad-Spectrum Antibiotic Use According to Hospice Utilization Among Patients with Cancer at the End of Life in South Korea - A Nationwide Analysis

Sep 23, 2026

Uploaded by Jasmine

Comparison of broad-spectrum antibiotic use between hospice and nonhospice cancer patients at end of life in South Korea using nationwide Korean National Health Insurance Service data from adults who died between 2018 and 2021. Hospice users were defined by inpatient, home-based, or consultation-based hospice care prior to death, with propensity score matching (1:2) to balance baseline characteristics. Broad-spectrum antibiotics were assessed during the last 3 months via prescription proportions and days of therapy per 1,000 patient-days. Matched analyses showed lower use (74.6% vs 79.0%) and reduced therapy days in hospice across intervals, with largest differences in the final week and last 3 days of life.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages10

Reading Time25 min

AccessFree to download

Introduction

Purpose and context

Methods and study design

Results and antibiotic exposure patterns

Conclusion and clinical implications

J Hosp Palliat Care 2026 June;29(2):41-50 [https://doi.org/10.14475/jhpc.2026.29.2.41](https://doi.org/10.14475/jhpc.2026.29.2.41) Original Article pISSN 2765-3072 •eISSN 2765-3080 Comparison of Broad-Spectrum Antibiotic Use According to Hospice Utilization Among Patients with Cancer atthe End of Life in South Korea: A Nationwide Analysis Ye Sul Jeung, M.D.*, Hak Jun Kim, B.S.†, Jiwon Yu, M.S.‡, Jeong-Han Kim, M.D., M.S.§, Jin-Ah Sim, Ph.D. ∥ and Shin Hye Yoo, M.D., Ph.D.*,¶ *Center for Palliative Care and Clinical Ethics, Seoul National University Hospital, Seoul,†Department of Artificial Intelligence Convergence, Hallym University, Chuncheon,‡Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul,§Division of Infectious Diseases, Department of Internal Medicine, Ewha Womans University Mokdong Hospital, Seoul,∥Graduate School of Public Health and Healthcare Management, The Catholic University of Korea, Seoul,¶Department of Human Systems Medicine, Seoul National University College of Medicine, Seoul, Korea Purpose: We aimed to compare broad-spectrum antibiotic use between hospice and nonhospice patients with cancer at the end of life using nationwide data from Korea. Methods: In this retrospective cohort study, we analyzed the Korean National Health Insurance Service data of adult patients with cancer who died between 2018 and 2021. Hospice users were defined as patients who received inpatient, home-based, or consultation-based hospice care before death. We applied propensity score matching (1:2) to balance the baseline characteristics of the hospice and non-hospice groups. Broad-spectrum antibiotic use, including anti-pseudomonal penicillins, anti-pseudomonal cephalosporins, carbapenems, and glycopeptides, was assessed during the last 3 months of life using prescription proportionsand days of therapy per 1,000 patient-days. Results: After matching, 38,102 hospice and 75,736 non-hospice users were analyzed. During the last 3 months of life, 74.6% of hospice and 79.0% of non-hospice users received at least one broad-spectrum antibiotic (P＜0.001). The proportion of patients receiving broad-spectrum antibiotics was generally lower among hospice users across all time intervals (P＜0.001), and the number of days of therapy was also lower, with the largest differences observed during the final week and last 3 days of life. Subgroup analyses showed the highest antibiotic exposure among patients with hematologic and pancreatobiliary cancers, particularly in the non-hospice group. Conclusion: Hospice involvement was associated with lower use and reduced exposure to broad-spectrum antibiotics among patients with cancer near the end of life. These findings support the alignment of end-of-life treatment decisions with the comfort-oriented goals of hospice care. KeyWords: Hospice care, Neoplasms, Anti-bacterial agents, Terminal care, Retrospective studies Received January 29, 2026 Revised May 1, 2026 Accepted May 13, 2026 Correspondence to Shin Hye Yoo ORCID: [https://orcid.org/0000-0001-7473-1082](https://orcid.org/0000-0001-7473-1082) [E-mail: ifi1024@gmail.com](E-mail: ifi1024@gmail.com) Funding/Support This study was supported by a grant from the Korean Society for Hospices and Palliative Care. Ye Sul Jeung and Hak Jun Kim equally contributed to this article. INTRODUCTION End-of-life (EOL) care for patients with cancer focuses on symptom relief, comfort, and avoidance of unnecessary treatments [1]. Hospice and palliative care support these goals by helping patients and families understand illness severity and This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ([http://creativecommons.org/licenses/by-nc/4.0/](http://creativecommons.org/licenses/by-nc/4.0/)) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Co

FAQs

What was the study’s main purpose?

To compare broad-spectrum antibiotic use between hospice and nonhospice cancer patients at the end of life using nationwide data from Korea.

How were hospice users and antibiotic exposure measured?

Hospice users were defined by inpatient, home-based, or consultation-based hospice care before death. Antibiotic exposure was assessed in the last 3 months using prescription proportions and days of therapy per 1,000 patient-days.

What were the key findings comparing hospice vs nonhospice groups?

After propensity score matching, hospice users had a lower proportion receiving at least one broad-spectrum antibiotic and fewer days of therapy, with the largest differences in the final week and last 3 days of life.

Sep 23, 2026

Uploaded by Jasmine