Antibiotic Overuse Surges in Final Months for Advanced Cancer Patients, South Korean Study Finds

[medi K / HEALTH IN NEWS] In a large-scale analysis of end-of-life care, researchers have uncovered a sharp rise in broad-spectrum antibiotic prescriptions for patients with advanced cancer, with usage peaking in the three months before death. The findings highlight the need for tailored antibiotic stewardship aligned with patients' conditions and treatment goals to curb potential harms like drug resistance and disrupted dignity in dying.

The study, led by Yoo Shin Hye, a professor at Seoul National University Hospital, alongside Kim Jung Han of Ewha Womans University Mokdong Hospital and Shim Jin Ah of Hallym University, drew on National Health Insurance Service data covering more than 515,000 South Korean patients with advanced cancer who died between 2002 and 2021. The team examined antibiotic use in the six months leading up to death.

More than half of the patients — 55.9 percent — received broad-spectrum antibiotics during this period, which target a wide range of bacteria but can also eliminate beneficial microbes, raising risks of side effects and antimicrobial resistance. Usage was most intense in the one-to-three-month window before death, with the volume of prescriptions concentrating in the two weeks to one month prior.

Even without clear evidence of infection, antibiotics were often administered based solely on fever or elevated inflammatory markers, the researchers noted.

Patterns varied by cancer type. Patients with hematologic malignancies — including non-Hodgkin lymphoma, leukemia, and multiple myeloma — had higher rates and volumes of antibiotic use than those with solid tumors such as lung, liver, or stomach cancer. Leukemia patients, for instance, were 1.5 times more likely to receive antibiotics in the immediate pre-death period and consumed 1.21 times the volume compared with lung cancer patients.



"The data reveal a clear pattern: hospitalizations and antibiotic treatments intensify starting around three months before death, when physical function declines rapidly," the team wrote. They stressed the importance of patient-centered decision-making and palliative care approaches during this phase.

Yoo, the lead author, described the work as the first systematic, population-level examination of antibiotic use in the final stage of life for cancer patients in South Korea. "It provides critical evidence for developing antibiotic guidelines and palliative care policies," she said.

Kim added that while antibiotics remain essential when clear therapeutic benefits exist — even in terminal illness — unnecessary administration heightens side-effect risks, promotes resistance, and can interfere with a dignified death.

The research was supported by South Korea's Ministry of Health and Welfare under its Patient-Centered Medical Technology Optimization Research Program and published in *JAMA Network Open* (impact factor 13.8).

Kim Kuk Ju / press@themedik.kr

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