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.

Purpose: We aimed to compare broad-spectrum antibiotic use between hospice and non-hospice 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 (12) 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 proportions and 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.