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LncRNA ELF3-AS1 has been characterized as an oncogenic lncRNA in bladder cancer and oral cancer, whereas its role in non-small cell lung cancer (NSCLC) is unknown. In this study, the authors observed that ELF3-AS1 was upregulated in NSCLC tissues in comparison with that in paired nontumor tissues collected from 68 NSCLC patients. High expression levels of ELF3-AS1 predicted the poor survival of NSCLC patients. Expression levels of miR-212 were inversely and significantly correlated with the expression levels of ELF3-AS1 across NSCLC tissue samples. In NSCLC cells, overexpression of ELF3-AS1 led to downregulated miR-212 and increased methylation of miR-212 gene. In addition, overexpression of ELF3-AS1 inhibited the role of miR-212 in suppressing cancer cell invasion and migration. Therefore, ELF3-AS1 is upregulated in NSCLC and promotes cancer cell invasion and migration by downregulating miR-212 through methylation.

Background: Long noncoding RNA SNHG10 has been reported to promote the development of liver cancer. While by analyzing The Cancer Genome Atlas (TCGA) dataset we observed the downregulation of SNHG1...

Background: Hemoglobin is a prognostic factor for many cancer patients. However, its effect on the prognosis of patients with advanced cancer receiving palliative treatment is still unclear.Objective: The aim of this study was to assess whether hemoglobin can be used as a prognostic indicator for patients with advanced cancer receiving palliative treatment.Methods: From July 2013 to October 2015, 368 consecutive patients were treated in the palliative treatment center of the Shanghai Cancer Center of Fudan University. The data for 105 patients were extended in the follow-up. The cut-off value selected for hemoglobin was 100 g/L.Results: The median survival time of patients with low hemoglobin was shorter than that of patients with high hemoglobin (41 days vs. 84 days). In the follow-up readmission cohort (n = 105), the median survival time for patients with high hemoglobin (HHb → HHb) was 3.44 times longer than that of patients with low hemoglobin (HHb → LHb). Thus, both low hemoglobin and decreased hemoglobin were identified as independent prognostic factors for poor prognosis.Conclusions: In palliative treatment, hemoglobin can be used as a stratification factor to determine the prognosis of advanced cancer patients.

Background: Primary liver cancer, around 90% are hepatocellular carcinoma in China, is the fourth most common malignancy and the second leading cause of tumor-related death, thereby posing a significant threat to the life and health of the Chinese people. Summary: Since the publication of Guidelines for Diagnosis and Treatment of Primary Liver Cancer (2017 Edition) in 2018, additional high-quality evidence has emerged with relevance to the diagnosis, staging, and treatment of liver cancer in and outside China that requires the guidelines to be updated. The new edition (2019 Edition) was written by more than 70 experts in the field of liver cancer in China. They reflect the real-world situation in China regarding diagnosing and treating liver cancer in recent years. Key Messages: Most importantly, the new guidelines were endorsed and promulgated by the Bureau of Medical Administration of the National Health Commission of the People’s Republic of China in December 2019.

Background：This study is to analyze the occurrence and clinical characteristics of cancer pain in advanced non-small cell lung cancer (NSCLC) patients who referral to palliative care treatment, as well as correlation between pain performance and clinical characteristics, laboratory indicators, and previous treatment.Methods ：Advanced NSCLC patients referred to the Palliative Care Unit (PCU) from January of 2016 to December of 2018 were included in our study. The Brief Pain Inventory (BPI) was used to evaluate cancer pain (CP). Results: Of 54 (56.7%) patients reported with pain, there were 23 patients (42.6%) who suffered from severe pain (score >=7) at the admission. There was a significant difference in the frequency of pain between patients with and without bone metastasis (p= 0.006), between patients with more than two sites and non-more than two sites metastasis (p=0.032). Patients received epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKI) had lower pain prevalence (p=0.033). Patients with bone metastases (p=0.005), with more than two metastases (p=0.022) and those with higer C-reactive protein (CRP) index (p= 0.012) had higher mean scores of pain, with significant differences. Conclusions:Our study showed the general characteristics, pain performance and related factors of advanced NSCLC patients who referral to palliative care service. This study confirmed that these patents’ clinical manifestations of pain were correlated with bone metastasis, metastasis with more than two sites, elevated CRP, and the EGFR-TKI usage. Whether there is a certain potential connection between these factors deserves further study.

In this study, a simple and reliable liquid chromatography tandem mass spectrometric method was first developed for the determination of capivasertib in dog plasma with ipatasertib as internal standard. The plasma samples were deproteinated using acetonitrile. An Acquity BEH C18 column (1.7 μm, 2.1 × 50 mm) maintained at 40°C was used for chromatographical separation, with water containing 0.1% formic acid and acetonitrile as mobile phase. Multiple reaction monitoring transitions were m/z 429.2 > 135.1 for capivasertib and m/z 458.2 > 387.2 for ipatasertib, respectively. Excellent linearity was achieved in the concentration range of 1-1,000 ng/ml with a correlation coefficient of >0.9981. The lower limit of quantification was 1 ng/ml. The extraction recovery of capivasertib from dog plasma was >85.81% and no significant matrix effect was found. The intra- and inter-day precision was

Vasculogenic mimicry (VM) refers to a new tubular network of the blood supply system with abundant extracellular matrix. VM is similar to capillaries but does not involve endothelial cells. As a traditional herbal medicine commonly used in China, baicalein possesses anti-inflammatory and lipoxygenase activities. However, the effects of baicalein on the process of VM formation in non-small cell lung cancer (NSCLC) and the underlying mechanisms have remained poorly understood. In this study, baicalein was found to inhibit the viability and motility of A549 cells and induced the breakage of the cytoskeletal actin filament network. In addition, baicalein significantly decreased the formation of VM and downregulated the expressions of VM-associated factors, such as VE-cadherin, EphA2, MMP14, MMP2, MMP9, PI3K and LAMC2, similar to the effects of ROCK inhibitors. Indeed, baicalein inhibited RhoA/ROCK expression in vitro and in vivo, suggesting the underlying mechanisms of reduced VM formation. Collectively, baicalein suppressed the formation of VM in NSCLC by targeting the RhoA/ROCK signaling pathway, indicating that baicalein might serve as an emerging drug for NSCLC.

Background: In patients with advanced cancer, considering the increased application of targeted therapy and immunotherapies, we explored the difference between indicators of chemotherapy and targeted therapy in the last month of life.Methods: Electronic medical data of patients who died from metastatic cancer and received targeted therapy and palliative chemotherapy from April 2007 to December 2018 at the Department of Integrated Therapy, Fudan University Shanghai Cancer Center were analyzed retrospectively. To determine those variables that were judged to be independent predictors of the use of palliative chemotherapy and targeted therapy, and the differences between them, univariate and multivariate analyses were used.Results: Of the 585 patients included in the study, 87 (14.9%) received palliative chemotherapy and 125 (21.3%) underwent targeted therapy during the last month. Patients who received continued chemotherapy within the last month were subjected to more intensive treatment (admitted to an intensive care unit (ICU) in the last month of life (OR, 2.33; CI [1.91–2.92], P < 0.001), and received cardiopulmonary resuscitation(OR, 4.18; CI [2.91–5.40],P < 0.001)), than those who did not. Analysis of subgroups showed that the lung cancer was independently associated with targeted therapy, and admission to an ICU was independently associated with palliative chemotherapy.Conclusions: Younger patients without complications and with better performance status were more likely to receive chemotherapy. Lower rates of cardiopulmonary resuscitation and admission to ICU correlated with receipt of targeted therapy at the end of life compared with those who received chemotherapy in the last 30 days.

BACKGROUND For patients with metastatic cancer, treatment with palliative chemotherapy can lead to more aggressive end-of-life (EOL) care. This retrospective study aimed to assess the time from the last chemotherapy treatment to death and investigate the variables associated with the delivery of palliative chemotherapy near the end of life. METHODS Data from patients who died from metastatic cancer after receiving palliative chemotherapy from April 2007 to June 2019 at the Department of Integrated Therapy of Fudan University, Shanghai Cancer Center were analyzed. Statistical analysis was performed to evaluate variables including the patient's age, Charlson comorbidities, caregivers, and the type of cancer. RESULTS A total of 605 patients were included in the analysis, of whom 335 (58.7%) were treated with palliative chemotherapy during their last year of life and 16.2% were treated in their last month of life. Treatment with palliative chemotherapy in the last month was independently associated with age (P

Background The lymphocytes played an important role in the natural history of cancer. The aim of this study was to explore the prognostic value of lymphocyte count and percentage for survival in advanced cancer patients receiving palliative care. Methods A retrospective review of clinicopathological data from 378 consecutive advanced cancer patients and 106 extended follow-up patients treated with palliative care was conducted. Kaplan–Meier curves and multivariate cox regression analyses were used to evaluate the relationships of peripheral lymphocyte count (LC) and lymphocyte to white blood cell ratio (LWR) with overall survival (OS). Results The median values for pretreatment LC and LWR were 1.1 (IQR, 0.8 ~ 1.5 × 109/L) and 0.138 (IQR, 0.086 ~ 0.208). The median survival times across LWR quartiles were 19, 47, 79, and 101 days (P

Background This study was carried out to investigate the prognostic value of baseline and dynamic changes in anxious emotion in advanced cancer patients undergoing palliative care. Methods The association between anxious emotion and survival was investigated in a retrospective sample of 377 consecutive advanced cancer patients receiving palliative care from August 2013 to October 2015 and in an extended follow-up study of 106 of those patients. Results The prevalence of anxious emotion was 24.93% (94/377) overall, 22.48% (47/209) in men and 27.97% (47/168) in women. Significant associations between baseline anxious emotion and overall survival (OS) were not found in the whole sample or in women. However, univariate and multivariate analyses showed that anxious emotion was an independent prognostic indicator of OS in men (hazard ratio [HR]: 1.811, P = .003). Moreover, findings showed that newly developed anxious emotion was significantly associated with poor OS in all readmitted patients (HR: 5.568, P

Background: The American Society of Clinical Oncology recently recommends patients with metastatic non-small cell lung cancer (NSCLC) should be offered palliative care services earlier. We sought to investigate the timing of palliative care referral of Chinese patients with NSCLC in our center. Method: Retrospective medical data including demographic characteristics and referral information were collected for analysis. Overall survival (OS) was calculated as the time since cancer diagnosis till patient’s death. The time interval from palliative care (PC) referral to a patient’s death (PC-D) was calculated. The PC-D/OS ratio was calculated to illustrate the comparison of the duration of PC in the overall length of disease. Results: The mean age of 155 patients with advanced NSCLC was 62.83 years. Before referral to PC, 128 patients received anticancer treatment including surgeon (46.5%). Sixty-three (40.6%) patients died in palliative care unit. The median OS of 144 patients with end cutoff was 19 months (mean = 31.49, 95% confidence interval [CI] = 25.86-37.12). The median PC-D was 41 days (mean = 73.84, 95% CI = 60.37-87.40). The mean interval of PC-D/OS of 144 patients with definitely death time was 0.22 (SD: 0.27, 95% CI: 0.17-0.26). The median interval was 0.089. More than half of patients (n = 75, 51.8%) underwent PC less than 1% time (PC-D/OS < 0.1) of their whole disease course. Patients who were indigenous to Shanghai ( P = .013) and who had brain metastasis ( P = .072) had the potential longer PC-D/OS ratio. A high proportion of patients reported loss of appetite (92.8%) and fatigue (91.4%) at the initial of referral to PC. Conclusion: This retrospective study, in a population of patients with advanced NSCLC, gave detailed information about PC services in a tertiary cancer center.

Objective Apply Chinese VR-CoDES in ophthalmic setting and describe patients’ worries and the doctor’s responses. Explore cultural differences in coding. Methods 102 audio-taped consultations of 84 patients were coded by Chinese version of VR-CoDES. The intra-class correlation coefficient (ICC) was used to test inter/intra-rater reliability, and inductive content analysis was conducted. Results The ICCs of inter-rater reliability for cues/concerns and responses were 0.78 and 0.81, and intra-rater reliability were 0.87 and 0.99, respectively. Cues were more frequent than concerns and elicited often by patients. Explicit Reduce Space (ER) was the most frequent response. Interruptions and the doctor’s repetitions were evident. Some expressions were not specified in the coding manual. Patients concerned about treatment effect (22 %), expenses (18 %), risk of operation (14 %), and pain (10 %). Conclusion The Chinese VR-CoDES can be applied to clinical consultations in China. Ophthalmic patients often expressed cues which were frequently elicited by themselves. The ophthalmologist preferred to give ER response. Interruptions and the ophthalmologist’s repetitions were difficult to code. More Chinese expressions should be collected to reduce cultural difference when coding. Practice implication VR-CoDES will be helpful in doctor-patient communication and medical education. VR-CoDES should undergo cultural adaptions in China.

Background: The C-reactive protein/albumin (CRP/Alb) ratio has been reported as a prognostic factor of survival for patients with a variety of cancers. However, its prognostic impact for a...

Background Although palliative care has been accepted throughout the cancer trajectory, accurate survival prediction for advanced cancer patients is still a challenge. The aim of this study is to identify pre-palliative care predictors and develop a prognostic nomogram for overall survival (OS) in mixed advanced cancer patients. Methods A total of 378 consecutive advanced cancer patients were retrospectively recruited from July 2013 to October 2015 in one palliative care unit in China. Twenty-three clinical and laboratory characters were collected for analysis. Prognostic factors were identified to construct a nomogram in a training cohort (n = 247) and validated in a testing cohort (n = 131) from the setting. Results The median survival time was 48.0 (95% CI: 38.1–57.9) days for the training cohort and 52.0 (95% CI: 34.6–69.3) days for the validation cohort. Among pre-palliative care factors, sex, age, tumor stage, Karnofsky performance status, neutrophil count, hemoglobin, lactate dehydrogenase, albumin, uric acid, and cystatin-C were identified as independent prognostic factors for OS. Based on the 10 factors, an easily obtained nomogram predicting 90-day probability of mortality was developed. The predictive nomogram had good discrimination and calibration, with a high C-index of 0.76 (95% CI: 0.73–0.80) in the development set. The strong discriminative ability was externally conformed in the validation cohort with a C-index of 0.75. Conclusions A validated prognostic nomogram has been developed to quantify the risk of mortality for advanced cancer patients undergoing palliative care. This tool may be useful in optimizing therapeutic approaches and preparing for clinical courses individually. Electronic supplementary material The online version of this article (10.1186/s12904-019-0432-7) contains supplementary material, which is available to authorized users.

Figure S1. Flow chart of the survival data collection. Figure S2. DCA for the nomogram. (DOC 119 kb)

Objective:Routine early integration of palliative care with advanced cancer management is not yet a part of standard practice in many countries, including mainland China. Whether patients in China suffering from advanced cancer are referred to palliative care services in a timely manner remains unclear. We sought to investigate the timing of palliative care referral of Chinese cancer patients at our center and its predictors.Method:Retrospective medical data including demographic characteristics and referral information were collected for analysis. A total of 759 patients referred to our palliative care unit (PCU) from January of 2007 to December of 2013 were included in the final analysis.Results:The mean age of the 759 patients included in the study was 62.89 years (range 61.95–63.82). Some 369 patients (48.6%) were male and 559 (73.6%) Shanghainese (indigenous). Lung cancer (17.9%) was the most common diagnosis. The time interval since enrollment into the PCU until a patient's death (length of stay, LOS) was calculated. A longer LOS indicated earlier referral to inpatient PC services. The median LOS was 21 days (CI95% = 19.79–22.21). Multivariate analysis showed that whether or not the patient was indigenous (p = 0.002) and younger than 65 (p = 0.031) were independent factors for a longer LOS. Such other characteristics as gender and primary cancer type bore no relationship to LOS.Significance of results:Our findings demonstrate that Chinese cancer patients are referred relatively late in the course of their disease to inpatient palliative care services. To overcome the barriers to early integration of palliative care into a patient's treatment plan, accurate information about palliative care must be provided to both oncologists and patients via comprehensive and systematic educational programs.

Flow chart of patients excluded from the study. (DOCX 28Â kb)

Purpose: To describe the preference of place of death among Chinese patients with cancer and their caregivers and to identify factors associated with the preference. Methods: A prospective questionnaire research was conducted in terminally ill patients with cancer and their caregivers. Questions included sociodemographic characteristics and information about patients’ diseases and patients’ preference of place of death. Results: Home (53.64%) was the first choice for 522 patients, 51.34% of participated caregivers chose home as the preferred place of death, and patient–caregiver dyads achieved 84.10% agreement. Patients who lived in rural area, with lower education level and lived with relatives, expressed more preference to die at home. Conclusion: This study described information about the preference of place of death and its potential predictive factors in terminally ill patients with cancer in mainland of China.

// Weiwei Zhao 1,2,* , Peng Wang 2,3,* , Huixun Jia 2,4 , Menglei Chen 1 , Xiaoli Gu 1 , Minghui Liu 1 , Zhe Zhang 1 , Wenwu Cheng 1,2 and Zhenyu Wu 5 1 Center for Biomedical Statistics, Fudan University Shanghai Cancer Center, Shanghai, China 2 Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China 3 Department of Integrative Oncology, Fudan University Shanghai Cancer Center, Shanghai, China 4 Center for Biomedical Statistical, Fudan University Shanghai Cancer Center, Shanghai, China 5 Department of Biostatistics, School of Public Health, Key Laboratory of Public Health Safety and Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai, China * These authors have contributed equally to this work Correspondence to: Zhenyu Wu, email: // Wenwu Cheng, email: // Keywords : neutrophil count, neutrophil percentage, prognostic value, advanced cancer, palliative care Received : November 15, 2016 Accepted : March 09, 2017 Published : March 22, 2017 Abstract The purpose of this study was to evaluate the count and percentage of neutrophils as prognostic indicators in advanced cancer patients undergoing palliative care. 378 consecutive patients receiving treatment at the palliative care unit of Fudan University Shanghai Cancer Center between July 2013 and October 2015 were reviewed. In 106 of these patients, the data were extended during the follow-up. The cut-off values selected for the neutrophil count and percentage were 8.0×10 9 /L and 85%, respectively. Both a high pretreatment neutrophil count ( HR = 1.828, 95% CI: 1.409~2.371, P

The objective of this study was to investigate the prognostic value of pretreatment NLR and its dynamic changes responsive to palliative care in advanced cancer patients. The study was retrospectively assessed in 378 consecutive advanced cancer patients receiving palliative care and in an extended follow-up study of 106 of those patients. The cutoff value of pretreatment NLR was determined to be 3.0. In the 378 advanced cancer patients, 89 had pretreatment NLR ≤ 3 and 289 had an NLR > 3. Univariate and multivariate analyses showed that tumor stage, palliative care, albumin level and pretreatment NLR (HR: 1.514, 95% CI: 1.125~2.038, P = 0.006) were independent prognostic indicators of OS. Moreover, in the follow-up cohort of 106 readmitted patients, 43 patients achieved a decreased NLR after palliative care, while the remaining 63 patients showed an increased NLR. Univariate and multivariate analyses showed that an increase in NLR was significantly associated with a poor survival (HR: 2.506, 95% CI: 1.474~4.261, P = 0.001). In conclusion, pretreatment NLR and changes in NLR independently predicted OS in advanced cancer patients undergoing palliative care. Incorporating NLR into clinical practice may better inform the prognosis and therapy decisions of advanced cancer patients in palliative settings.

This study was carried out to investigate the prognostic value of baseline and dynamic changes in anxious emotion in advanced cancer patients undergoing palliative care.The association between anxious emotion and survival was investigated in a retrospective sample of 377 consecutive advanced cancer patients receiving palliative care from August 2013 to October 2015 and in an extended follow-up study of 106 of those patients.The prevalence of anxious emotion was 24.93% (94/377) overall, 22.48% (47/209) in men and 27.97% (47/168) in women. Significant associations between baseline anxious emotion and overall survival (OS) were not found in the whole sample or in women. However, univariate and multivariate analyses showed that anxious emotion was an independent prognostic indicator of OS in men (hazard ratio [HR]: 1.811, P = .003). Moreover, findings showed that newly developed anxious emotion was significantly associated with poor OS in all readmitted patients (HR: 5.568, P .001), in men (HR: 5.104, P = .006) and women (HR: 5.820, P = .004).Our study suggests that anxious emotion, especially dynamic changes in anxious emotion, needs to be monitored in advanced cancer patients; whether targeted interventions would prolong survival requires further studies.

Background Oncologists` knowledge and attitudes to palliative care (PC) and end of life (EOF) should be highlighted in order to give them effective education. This study is intended to provide a descriptive analysis of oncologists’ knowledge, attitudes and practice toward PC and EOF issues in Mainland China. Methods The questionnaire survey with 24 items investigating oncologists’ demographic information, knowledge and attitudes toward PC and EOF issues was conducted among Chinese Oncology clinicians. Results The participants had a mean of 10.10 years practice in oncology. 43 (31.2 %) participants had received PC education. 73.9 % of the participants believed that PC should be considered when patients were not suitable to take surgery, radiotherapy, chemotherapy and other anti-cancer therapies. 72.5 % of the participants believed that early PC integration can improve the quality of life in patients. Most of the oncology clinicians (73.9 %) believed that the doctor-in-charge was the appropriate person to inform patients of the diagnosis. However, only 11 participants chose to inform the diagnosis and disease prognosis to the patients, whereas 39.9 % of the participants chose to disclose it to Family/Caregivers first. Besides, Chinese oncologists were obviously unfamiliar with the concepts of euthanasia and related issues. Conclusions This study indicated the insufficient knowledge toward PC and related issues of the Chinese oncologists. More attention should be paid on the education of PC among Oncologists in Mainland China.

Backgrounds Intra-abdominal placement of the Central Venous Catheter (CVC) was conducted to manage the ascites-related symptoms of non-ovarian cancer patients. The aim of this study is to document the efficacy of symptom relief and conduct survival analysis of non-ovarian cancer patients with malignant ascites who received paracentesis and indwelling catheter drainage. Methods Seventy eight patients received paracentesis and drainage. All patients who met the inclusion criteria were included in this study. The overall survival (OS) was defined as the interval between initial diagnosis and death. Since-paracentesis survival (SP-Survival) was defined as the interval between initial paracentesis and death. Results Hepatic cancer was the most frequent original cancer in this study. Peritoneal catheters remained in situ for a median of 13 days. No immediate complications, such as perforation of a viscus or excessive bleeding, were encountered during placement. All ascites-related symptoms improved after drainage compared with the baseline. There was a statistically significant improvement in the mean score for abdominal swelling (p

Different countries have various decision-making practices, which are formalized according to laws, rules, traditions, religious beliefs, and ethical views of different cultural backgrounds. We investigated the characteristics and factors associated with the decision-making details in terminally ill cancer patients in a tertiary cancer center in Shanghai, China. A single center, retrospective study was performed among advanced cancer patients who died between March 2007 and December 2013 in ward at Palliative Care Unit, Fudan University Shanghai Cancer Center. Of 436 patients’ end-of-life (EOL) discussions, 424 (97.2 %) occurred between family caregivers and physicians. The main decision-maker was in the following order: spouse (45.6 %), offsprings (44.3 %), parents (3.2 %), son-/daughter-in-law (1.8 %), and relatives (1.4 %). Two hundred twenty-one (47.3 %) patients received at least one of six life-sustaining treatments. One hundred eighty-four (40.4 %) patients continued artificial nutrition and hydration (ANH) until death. Cardiopulmonary resuscitation (CPR) was performed in 26 patients (6.0 %). Two hundred fourteen (49.1 %) patients received vasopressors before death. Only two patients received mechanical ventilation and only one patient received tracheostomy. The median time interval since the decision made till death was 20.17 h (95 % CI = 18.94–21.40, range 4.3 to 70.2 h). Patients who were older than 65 years old were less likely to undergo an intensive procedure (AOR = 0.559, 95 % CI = 0.367–0.852, p = 0.007). Patients living in urban settings (AOR = 2.177, 95 % CI = 1.398–3.390, p = 0.001) were more likely to undergo an intensive procedure in the EOL period. This study reflected some Chinese characteristics for decision-making at the end of life among advanced cancer patients. More prospective studies focused on specific EOL issues are required to improve the quality of EOL care.

Background Considering the particularity of Chinese culture, with a long history of traditional ethics rooted in Confucianism, significant differences between Chinese and Western cultures exist in clinical practice. Following the western recommendations is a tough process for palliative care implementation in China. Therefore, it is essential to present some important experience for implementing the palliative care for Chinese terminally ill cancer patients from the aspect of culture understanding. Method 648 patients received palliative care in our department between 2007–2011 (342 patients died in the ward). The authors summarised the understanding of Chinese culture difference as physician servicing in palliative care Department in Shanghai Cancer Centre Fudan University since March, 2007. Results The authors rooted the Chinese cultural differences from four aspects: the truth telling, the decision-making, issues about the survival length, the acceptance of death of cancer. Concealing the serious diagnoses from patients in China is common. The decision-making occurred always together with the patients9 family. For serious diagnoses or fatal prognoses, physicians usually first inform a close member of the patient9s family. It then becomes the family9s decision whether to tell the patients the truth. So this is actually a barrier to conduct the research to understand the perception about death among Chinese terminally ill cancer patients themselves. As for acceptance of death, nearly 43% patients9 caregivers asked for not resuscitate medication and asked for stopping the hydration, 26.90% died patients9 relatives asked for sedation to relieve the suffering on their own initiative. Conclusion The discrepancy do existed in the implementation of palliative care between China and Western countries. The rooted cultural reasons maybe: the value and appreciation of filial duty connotation, obscurity, responsibility and the deep-rooted traditional Chinese death attitudes.

Purpose Where people die may influence the quality of their death, little is known about the choice for place of death of cancer patients in Shanghai, China. Considering the culture difference and palliative care implement, we organised a prospective questionnaire based on the choice death place between terminally ill cancer patients and their families. Methods: Among 4 years, 352 Patient-family care giver dyads were surveyed. The main outcome variables of the study were age, sex, income, marital status, living condition, religious beliefs, medical resources, the choice of the place of death and its reason. Descriptive statistics, χ 2 , κ coefficients were used. Determinants of congruence on preferences were identified by multivariate logistic regression. Results The majority choice of death place was home (82.5% and 72.3%). Patient-care giver dyads achieved 68.5% agreement on the preferred place of death. The κ coefficient of congruence was 0.59 (95% CI 0.54 to 0.66) For patients, worries of being a burden to others is the first reason for the choice of home; for families, the first reason was culture concerns. The Logistic regression analysis revealed the following independent predictors of preferring to die at home: age and living conditions. Conclusion This study described the preference of the death place choice and potential influencing factors and revealed the possibility for the integration of effective home care model in Shanghai Palliative Care programs. Effective interventions need to be developed avoid unnecessary re-hospitalisations and unfavourable hospital deaths, and improve accordance with the patients9 wishes. Acknowledge for the funding form helped the hospice: The preference of place of death between terminally ill cancer patients. (Funding NO: 2005383)

Background There are a number of studies dedicated to characteristics of sedation, but these studies are mostly bound to western country practices. The aim of this study is to describe the characteristics of patients who suffered from cancer and who had been sedated until their death in Shanghai, China. Methods Retrospective medical data of 244 terminally ill cancer patients including 82 sedated patients were collected. Data collected included demographic characteristics, disease-related characteristics and details of the sedation. Results In sedated cases, patients and/or caregivers gave the consent to start palliative sedation due to unmanageable symptoms. On average, sedation was performed 24.65(±1.78)hours before death. Agitated delirium and dyspnea were the most frequent indications for palliative sedation. There was no significant difference in survival time from admission till death between sedated and non-sedated patients (p > 0.05). Conclusions Palliative sedation is effective for reducing terminally ill cancer patients’ suffering without hastening death. Prospective research is needed to determine the optimal conditions for Chinese patients including indications, decision making process, informed consent, cultural and ethical issues, type of sedation and drugs.