Place of Death and Its Determinants for Patients with Cancer in Singapore: An Analysis of Data from the Singapore Cancer Registry, 2000–2009

Hong, Cassandra; Chow, Khuan Yew; Poulose, Jissy Vijo; Jin, Ai Zhen; Devi, Anju; Chee, Eddie Meng Fai; Goh, Cynthia

doi:10.1089/jpm.2011.0092

Cited by 40 publications

(52 citation statements)

References 20 publications

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“…Like previous local studies, we confirm older age, female, Malay ethnicity and home palliative care involvement to be associated with home deaths. [6,7] Additionally, we found that primary brain cancer, metastatic disease and non-Medifund patients were more likely to die at home.…”

Section: Discussionmentioning

confidence: 73%

“…[2,3] Similar to global trends, cancer incidence is on the rise in Singapore; with cancer accounting for 30% of total population mortality. [4,5] Additionally, more than 50% of cancer decedents die in Singapore hospitals, [6,7] despite a majority patient preference for home deaths. [8][9][10][11][12] Respecting preferences in terms of place of care and death is important.…”

Section: Introductionmentioning

confidence: 99%

“…[31][32][33][34][35] Within Singapore, factors found to be associated with home death include age, female gender, Malay ethnicity, receipt of home palliative care, having a caregiver, non-cancer diagnosis, fewer prior hospitalizations and a preference for home death. [6,7,36] PLOS ONE While a recent systematic review concluded that low socioeconomic status increased the odds of hospital deaths, this conclusion was weaker for Asian countries due to a lack of published studies within this region. [37] To the best of our knowledge, local literature defining cancer specific risk factors for hospital deaths is also currently lacking; and remains critical in future identification of patients with unmet needs.…”

Section: Introductionmentioning

confidence: 99%

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Sociodemographic and clinical factors for non-hospital deaths among cancer patients: A nationwide population-based cohort study

et al. 2020

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Background Factors associated with place of death inform policies with respect to allocating end-of-life care resources and tailoring supportive measures. Objective To determine factors associated with non-hospital deaths among cancer patients. Design Retrospective cohort study of cancer decedents, examining factors associated with nonhospital deaths using multinomial logistic regression with hospital deaths as the reference category. Setting/subjects Cancer patients (n = 15254) in Singapore who died during the study period from January 1, 2012 till December 31, 2105 at home, acute hospital, long-term care (LTC) or hospice were included. Results Increasing age (categories �65 years: RRR 1.25-2.61), female (RRR 1.40; 95% CI 1.28-1.52), Malays (RRR 1.67; 95% CI 1.47-1.89), Brain malignancy (RRR 1.92; 95% CI 1.15-3.23), metastatic disease (RRR 1.33-2.01) and home palliative care (RRR 2.11; 95% CI 1.95-2.29) were associated with higher risk of home deaths. Patients with low socioeconomic status were more likely to have hospice or LTC deaths: those living in smaller housing

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Section: Discussionmentioning

confidence: 73%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Sociodemographic and clinical factors for non-hospital deaths among cancer patients: A nationwide population-based cohort study

et al. 2020

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“…46 Diversely, in New York and in Singapore, home deaths increase with age. 41,47 In order to enable more cancer patients to die at home and to tackle inequities, an understanding of the factors associated with death at home is required. Despite the predominance of a preference to die at home and increases in cancer home deaths in Canada, the United Kingdom and the United States, a home death is still far from being a reality for the majority of people dying of cancer in these and other countries.…”

Section: What Factors Are Associated With Home Care and Home Death?mentioning

confidence: 99%

Dying at home – is it better: A narrative appraisal of the state of the science

et al. 2013

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Background: Achieving home care and home death is increasingly used as an outcome measure of palliative care services. Aim: To appraise the state of the science on dying at home. Methods: Appraisal and narrative review developed from a plenary presentation at the European Association for Palliative Care (EAPC) 2012 meeting examining the research on variations and trends in place of death, factors associated with dying in the preferred place, presenting evidence on outcomes for those dying at home and suggesting future research questions. Results: Meeting patients' preferences and creating home-like environments has been a major concern for hospice and palliative care since its inception. During the 20 th century, in many countries, hospital deaths increased and home deaths reduced. Despite the fact that this trend has been halted or reversed in some countries (notably the United States, Canada and, more recently, the United Kingdom) in the last 5-20 years, a home death is still a distant reality for the majority, even though evidence shows it is the most commonly preferred place to die. Epidemiological studies identified factors associated with home death, including affluence, patients' preferences, provision of home care and extended family support. Evidence about the benefits of home care is conflicting, but recent data suggest that holistic well-being may be greater at home. Implications: We call for further analyses of variations in place of care and place of death and robust studies on how patients and families formulate and change preferences over time. Regular monitoring of outcomes, quality and costs of palliative home care is urged.

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“…[1][2][3][4][5][6] While this preference is increasingly being met in the UK, a large proportion of people still do not die in their preferred place; 7 8 and this is particularly apparent among patients with haematological malignancies, in the UK and elsewhere. [8][9][10][11][12][13][14] Haematological malignancies are complex cancers, broadly categorised as leukaemias, lymphomas and myeloma, but actually comprising numerous different subtypes. These diseases can be indolent or aggressive and may be incurable at diagnosis, potentially curable or manageable with medication in a way similar to chronic rather than malignant conditions.…”

Section: Introductionmentioning

confidence: 99%

Preferred and actual place of death in haematological malignancy

Howell

Wang

Roman

et al. 2015

BMJ Support Palliat Care

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ObjectivesHome is considered the preferred place of death for many, but patients with haematological malignancies (leukaemias, lymphomas and myeloma) die in hospital more often than those with other cancers and the reasons for this are not wholly understood. We examined preferred and actual place of death among people with these diseases.MethodsThe study is embedded within an established population-based cohort of patients with haematological malignancies. All patients diagnosed at two of the largest hospitals in the study area between May 2005 and April 2008 with acute myeloid leukaemia, diffuse large B-cell lymphoma or myeloma, who died before May 2010 were included. Data were obtained from medical records and routine linkage to national death records.Results323 deceased patients were included. A total of 142 (44%) had discussed their preferred place of death; 45.8% wanted to die at home, 28.2% in hospital, 16.9% in a hospice, 5.6% in a nursing home and 3.5% were undecided; 63.4% of these died in their preferred place. Compared to patients with evidence of a discussion, those without were twice as likely to have died within a month of diagnosis (14.8% vs 29.8%). Overall, 240 patients died in hospital; those without a discussion were significantly more likely to die in hospital than those who had (p≤0.0001). Of those dying in hospital, 90% and 75.8% received haematology clinical input in the 30 and 7 days before death, respectively, and 40.8% died in haematology areas.ConclusionsMany patients discussed their preferred place of death, but a substantial proportion did not and hospital deaths were common in this latter group. There is scope to improve practice, particularly among those dying soon after diagnosis. We found evidence that some people opted to die in hospital; the extent to which this compares with other cancers is of interest.

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Place of Death and Its Determinants for Patients with Cancer in Singapore: An Analysis of Data from the Singapore Cancer Registry, 2000–2009

Abstract: Knowledge about place of death and its determinants will facilitate the planning of healthcare services to enable patients with terminal cancer to die at home and in in-patient hospices, thereby avoiding inappropriate hospitalization at the end of life.

Cited by 40 publications

References 20 publications

Sociodemographic and clinical factors for non-hospital deaths among cancer patients: A nationwide population-based cohort study

Sociodemographic and clinical factors for non-hospital deaths among cancer patients: A nationwide population-based cohort study

Dying at home – is it better: A narrative appraisal of the state of the science

Preferred and actual place of death in haematological malignancy

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