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End-of-life care in cancer and dementia: a nationwide population-based study of palliative care policy changes
  1. Lou-Ching Kuo1,2,
  2. Jung Jae Lee3,
  3. Denise Shuk Ting Cheung3,
  4. Ping-Jen Chen4,5,6 and
  5. Chia-Chin Lin1,3,7
  1. 1 School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
  2. 2 Department of Nursing, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan
  3. 3 School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
  4. 4 Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City 807, Taiwan
  5. 5 School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City 807, Taiwan
  6. 6 Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London W1T 7NF, United Kingdom
  7. 7 Alice Ho Miu Ling Nethersole Charity Foundation Professor in Nursing, Pokfulam, Hong Kong
  1. Correspondence to Professor Chia-Chin Lin, School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong; cclin{at}


Objectives The National Health Insurance programme started providing coverage for inpatient care in palliative care (PC) units of acute care hospitals in 2000; however, initially, only PC provided to patients with terminal cancer was covered. A PC policy that enabled PC reimbursement for patients with dementia was implemented in 2009. However, the association of this PC policy with end-of-life care remains unclear. The study aims to compare the association of the PC policy with end-of-life care between patients with dementia and patients with cancer during the last 6 months of their lives.

Methods We analysed the claims data of 7396 patients dying with dementia (PDD) and 24 319 patients dying with cancer (PDC) during 1997–2013.

Results Among PDC, while the percentage of receiving PC increased from 3.6% in 1999 to 14.2% by the end of 2000 (adjusted OR (aOR)=4.07, 95% CI 2.70 to 6.13) and from 20.9% in 2010 to 41.0% in 2013 (aOR=1.40, 95% CI 1.33 to 1.47), vasopressor use decreased from 71.6% in 1999 to 35.5% in 2001 (aOR=0.90, 95% CI 0.82 to 0.98). Among PDD, PC use increased from 0.2% in 2009 to 4.9% in 2013 (aOR=2.05, 95% CI 1.60 to 2.63) and cardiopulmonary resuscitation use decreased from 17.6% in 2009 to 10.0% in 2013 (aOR=0.83, 95% CI 0.76 to 0.90).

Conclusions Implementation of the PC policy in Taiwan was associated with improved PC utilisation among patients with cancer and dementia, which may reduce unnecessary medical care procedures.

  • Dementia
  • cancer
  • end-of-life
  • palliative care

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  • Contributors LCK and CCL made substantial contribution to the concept or design of the work; or acquisition, analysis or interpretation of data. LCK, JJL, DSTC, PJC and CCL drafted the article or revised it critically for important intellectual content. LCK, JJL, DSTC, PJC and CCL approved the version to be published. LCK, JJL, DSTC, PJC and CCL participated sufficiently in the work to take public responsibility for appropriate portions of the content.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study received ethical approval from the Taipei Medical University-Joint Institutional Review Board (N201510048).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement This study was based on data from the Taiwan National Health Insurance Research Database, which was provided by the National Health Insurance Administration, Ministry of Health and Welfare, and is managed by the National Health Research Institutes.