Dying from cancer or other chronic diseases in the Netherlands: ten-year trends derived from death certificate data

Abstract

BackgroundFor the further development of palliative care, it is relevant to gain insight into trends in non-acute mortality. The aim of this article is twofold: (a) to provide insight into ten-year trends in the characteristics of patients who died from cancer or other chronic diseases in the Netherlands; (b) to show how national death statistics, derived from physicians' death certificates, can be used in this type of investigations.MethodsSecondary analysis of data from 1996 to 2006 on the "primary" or "underlying" cause of death from official death certificates filled out by physicians and additional data from 2003 to 2006 on the place of death from these certificates.ResultsOf the 135,000 people who died in the Netherlands in 2006, 77,000 (or 57%) died from a chronic disease. Cancer was the most frequent cause of death (40,000). Stroke accounted for 10,000 deaths, dementia for 8,000 deaths and COPD and heart failure each accounted for 6,000 deaths. Compared to 1996, the number of people who died from chronic diseases has risen by 6%.Of all non-acute deaths, almost three quarters were at least 70 years old when they died. Almost one third of the people died at home (31%), 28% in a hospital, 25% in a nursing home and 16% somewhere else.ConclusionFurther investments to facilitate dying at home are desirable. Death certificate data proved to be useful to describe and monitor trends in non-acute deaths. Advantages of the use of death certificate data concern the reliability of the data, the opportunities for selection on the basis of the ICD-10, and the availability and low cost price of the data.

Early identification of palliative care patients in general practice: development of RADboud indicators for PAlliative Care Needs (RADPAC)

“…A general deterioration of the clinical situation (oedema, orthopnoea, nycturia, dyspnoea) 7. The patient mentions 'end of life approaching' Chronic obstructive pulmonary disease 1. The patient is moderately disabled; dependent; requires considerable assistance and frequent care (Karnofsky score ≤50%) 2.…”

“…1,2 In a substantial number of these cases, death results after a protracted end stage that may often last over a year: the palliative stage. Most patients prefer to spend the final phase of their lives primarily at home and also prefer to die there, 1,3 making the GP the most appropriate healthcare professional to initiate, provide, and coordinate palliative care. [4][5][6][7] Yet, only a minority of these palliative patients die at home.…”

Trends in place of death: The role of demographic and epidemiological shifts in end-of-life care policy

“…A shift in PoD from hospitals to nursing homes has been observed for most other countries, 5,[7][8][9]19,[23][24][25] but not all. 26 Like in Norway, this is likely to partly be a result of population ageing.…”

Requests for euthanasia in general practice before and after implementation of the Dutch Euthanasia Act

“…Cardiovascular disease seems to have become a less frequent and COPD a more frequent reason for a request for euthanasia, possibly reflecting recent trends in the incidence and mortality of these diseases. 14 Pain was a major reason for requesting euthanasia.…”