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Dying at home does not hasten death among patients with cancer
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Patients with cancer who died at home experienced similar or significantly longer time until death than those who died in a hospital, according to results of a prospective cohort study conducted in Japan.
Although a majority of people would prefer to be cared for and die at home, transitioning care to the home often does not occur until a very late stage of the disease, if at all. It has been thought that home care may shorten survival if quality of medical treatment provided at home is inferior to that provided in a hospital.
However, few studies have evaluated the difference in survival time of patients with advanced cancer dying at home vs. in a hospital.
Thus, Jun Hamano, MD, of University of Tsukuba in Japan, and colleagues evaluated data from 2,069 patients (mean age, 69.4 years; 58.3% men) with advanced cancer from 58 specialist palliative care services. Most patients had gastrointestinal (47.8%) or lung (21%) cancers.
Of these patients, 1,582 received hospital-based palliative care — 1,507 of whom actually died in a hospital, and 75 of whom died at home — and 487 received home-based palliative care, 100 of whom died in a hospital and 387 of whom died at home. In total, 1,607 patients died in a hospital and 462 died at home.
To adjust for factors that might influence survival time, researchers included date of referral into their analyses. They used the modified Prognosis in Palliative Care Study predictor model A to place patients into estimated prognosis groups of days (0-13 days), weeks (14-55 days) and months (more than 55 days).
In the days’ prognosis group, patients who died at home experienced significantly longer time until death than patients who died in the hospital (13 days vs. 9 days; P = .006). Patients in the weeks’ prognosis group also experienced longer time until death when they died at home (36 days vs. 29 days; P = .007).
However, patients in the months’ prognosis group experienced similar time until death whether they died at home or in a hospital (59 days vs. 62 days).
Results of an adjusted model showed place of death significantly influenced survival time (HR = 0.87; 95% CI, 0.77-0.97).
Home-based palliative care extended survival in the days’ prognosis group (13 days vs. 10 days; P = .039), regardless of whether the patient actually died at home. However, this effect did not persist in the weeks’ and months’ prognosis groups.
Overall, type of care received tended to influence survival time (HR = 0.91; 95% CI, 0.82; 1.02).
“The cancer patient and family tend to be concerned that the quality of medical treatment provided at home will be inferior to that given in a hospital and that survival might be shortened; however, our finding — that home death does not actually have a negative influence on the survival of cancer patients at all, and rather may have a positive influence — could suggest that the patient and family can choose the place of death in terms of their preference and values,” Hamano said in a press release. “Patients, families and clinicians should be reassured that good home hospice care does not shorten patient life, and even may achieve longer survival.” – by Alexandra Todak
Disclosure: The researchers report no relevant financial disclosures.
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