Going back to home to die: does it make a difference to patient survival?

Abstract

BackgroundMany patients wish to stay at home during the terminal stage of cancer. However, there is concern that medical care provided at home may negatively affect survival. This study therefore explored whether the survival duration differed between cancer patients who received inpatient care and those who received home care.MethodsWe retrospectively investigated the place of care/death and survival duration of 190 cancer patients after their referral to a palliative care consultation team in a Japanese general hospital between 2007 and 2012. The patients were classified into a hospital care group consisting of those who received palliative care in the hospital until death, and a home care group including patients who received palliative care at home from doctors in collaboration with the palliative care consultation team. Details of the place of care, survival duration, and patient characteristics (primary site, gender, age, history of chemotherapy, and performance status) were obtained from electronic medical records, and analyzed after propensity score matching in the place of care.ResultsMedian survival adjusted for propensity score was significantly longer in the home care group (67.0 days, n = 69) than in the hospital care group (33.0 days, n = 69; P = 0.0013). Cox’s proportional hazard analysis revealed that the place of care was a significant factor for survival following adjustment for covariates including performance status.ConclusionsThis study suggests that the general concern that home care shortens the survival duration of patients is not based on evidence. A cohort study including more known prognostic factors is necessary to confirm the results.

Multicenter cohort study on the survival time of cancer patients dying at home or in a hospital: Does place matter?

“…The most important finding of this study is that patients who died at home had a survival time similar to or significantly longer than that of patients who died in a hospital after adjustments for background factors with the proven prognostic classification Prognosis in Palliative Care Study model. This finding is consistent with the results of a preliminary study showing that patients receiving home‐based palliative care had significantly longer survival than those receiving hospital‐based palliative care with a median survival time of 67 days versus 33 days . Although that single‐center study used only 5 factors for adjustments, the current multicenter study compared survival with a validated prognostic classification.…”

“…Nonetheless, very few studies have investigated potential differences in the survival time of patients with advanced cancer dying at home or in a hospital. Also, a previous study was limited by a lack of adjustment for sufficient prognostic factors and was conducted at a single center with a small number of patients …”

“…9,10 One concern is that the quality of medical treatment provided at home will be inferior to that given in a hospital and that survival might be shortened. [11][12][13] Although a preliminary study revealed that patients receiving home-based palliative care had significantly longer survival than those receiving hospital-based palliative care, 14 whether the survival time is actually different according to the place of death remains unclear. Therefore, clarification of whether the survival time differs with the place of death (ie, home vs hospital) is important to ensure adequate timing in the use of home-based palliative care services.…”

“…Also, a previous study was limited by a lack of adjustment for sufficient prognostic factors and was conducted at a single center with a small number of patients. 14 Accordingly, the primary aim of this secondary analysis of a Japanese prospective, multicenter study was to investigate the potential difference in the survival time between cancer patients dying at home and cancer patients dying in a hospital through an assessment of a large sample with appropriate adjustments for prognostic factors.…”

Effect of Primary Care Involvement on End‐of‐Life Care Outcomes: A Systematic Review

“…This systematic review of the literature demonstrates that individuals with greater PCP involvement at the end of life are more likely to die out of the hospital, with home care, hospice care, or both. Dying with home or hospice care is associated with longer survival, less‐intensive healthcare use, and better quality of dying and death in terms of symptom control, death preparation, and relationships with family and medical staff than dying in the hospital. Furthermore, home or hospice care at the end of life is associated with lower caregiver burden, greater caregiver satisfaction, and lower likelihood of developing bereavement‐related psychiatric illness .…”