Place of death of Houston area residents with cancer over a two-year period

Abstract

The majority of cancer patients wish to die at home. Improved understanding of place of death and its relevant demographic predictors is important for the planning of palliative cancer care programs. The purpose of this study was to determine the place and predictors of site of death in cancer patients in a major U.S. metropolitan area. Death certificate data over two years were analyzed for Houston area residents with cancer who died in the Houston area. Information was obtained on factors that might be associated with the place where cancer patients die. For the purpose of this study, we looked at the following variables: primary site of cancer (hematological, breast, genitourinary, gastrointestinal, lung, and other); black, white, Hispanic, or Asian; age at death; marital status; sex; whether or not veteran of U.S. armed forces; levels of education; and area of residency within the Houston area. Univariate and multivariate analyses were performed. The majority of patients died in the hospital (51-52% both years), with the next most frequently occurring group dying at home (34-35% both years). Stepwise multivariate analysis resulted in a 6-variable logistic regression model. In this model, the odds of dying in hospital were increased by a factor of 2.7 if the patient had a hematological cancer (P<0.0001), a factor of 1.6 if the patient lived in Harris County (P<0.0001), and a factor of 1.5 if the patient was black (P<0.0001). Further characterization of factors associated with increased risk of hospital death rate is needed and systems should be developed to enable the majority of cancer patients to access palliative care services in the multiple settings in which they die.

Factors Associated with End-of-Life Health Service Use in Patients Dying of Cancer

“…There is also a discrepancy between what patients report as their preferred place of death (most often home) and actual place of death (Beccaro et al 2006;Bruera et al 2003;Burge et al 2003;Foreman et al 2006;gilbar and steiner 1996;karlsen and Addington-Hall 1998;Mcwhinney et al 1995;Heyland et al 2000;Pritchard et al 1998). People who die in institutions such as acute care facilities have unmet needs for symptom control, physician communication, emotional support and respectful treatment compared with those receiving patientcentred palliative care services at home (Teno et al 2004).…”

Quality of End-of-Life Cancer Care in Canada: A Retrospective Four-Province Study Using Administrative Health Care Data

“…The literature suggests that, over time, cancer care is becoming more aggressive near the eol 10,11 . The literature also suggests the presence of a discrepancy between what patients report as their preferred place of death (most often home) and their actual place of death [12][13][14][15][16][17][18][19][20] . Compared with people receiving patient-centred palliative care services at home, those who die in institutions such as acute care facilities have unmet needs for symptom control, physician communication, emotional support, and respectful treatment 21,22 .…”

Clinical, sociodemographic, and local system factors associated with a hospital death among cancer patients

“…Clinical factors associated with a hospital death are the type of cancer [6,9], extension of the disease (stage) [1,5], the presence of comorbidities [7,22], and survival time [16]. Sociodemographic factors include race [9,18], socioeconomic status [16], age [10], gender [10,12,16], marital status [10,16], and type of insurance [8,30].…”

“…Sociodemographic factors include race [9,18], socioeconomic status [16], age [10], gender [10,12,16], marital status [10,16], and type of insurance [8,30]. The influence of the local health care system resources on health outcomes has already been established by several researchers [16,26,27] Thus, if system factors influence patients' place of death, one would expect that at least end-of-life services would be available for patients dying in hospitals.…”