Introduction : Hepatobiliary and pancreatic (HBP) malignancy remains a highly lethal disease, with nearly 70-80% of patients presenting with metastatic or locally advanced disease. Recent chemotherapy for metastatic pancreatic cancer (FOLFIRINOX) improves median survival from 2–4 months to approximately 11 months in phase III trials. Even though this regimen increased survival, since the implementation of the POLST in Korea, paradigm it began to change. We described and analyzed the status of POLST and treatment in the real world and discuss about the principle of palliative care focused on HBP malignancy.

Methods : ween February 2018 and December 2019, we reviewed the terminal stage hepatobiliary and pancreas cancer patients who have already agree with POLST retrospectively.

Results : Total 158 patients of HBP malignancy were analyzed. The mean age was 65 years and proportion of hepatocellular carcinoma (HCC), cholangiocarcinoma and pancreatic cancer was 20.2% vs. 37.9% vs 41.9%. Symptoms were reported differently according to the types of cancer, In the case of hepatocellular carcinoma, 70% of patients suffered from abdominal distension due to malignant ascites, and 84% of patients of biliary tract cancer had jaundice and itching sense. Opioid analgesics were significantly used common in 96% of pancreatic cancer. Patients with HCC and biliary tract cancer had a high rate of treatment such as PTBD and PCD even after POLST. Previous operation history was significantly related with gastrointestinal obstructive symptom.

Conclusions : In the era of POLST, palliative treatments have become a major issue. Depending on the symptoms associated with the type of cancer, appropriate treatment should be applied