Place of Death in Patients with Lung Cancer: A Retrospective Cohort Study from 2004-2013

Abstract

IntroductionMany patients with cancer die in an acute hospital bed, which has been frequently identified as the least preferred location, with psychological and financial implications. This study looks at place and cause of death in patients with lung cancer and identifies which factors are associated with dying in an acute hospital bed versus at home.Methods and FindingsWe used the National Lung Cancer Audit linked to Hospital Episode Statistics and Office for National Statistics data to determine cause and place of death in those with lung cancer; both overall and by cancer Network. We used multivariate logistic regression to compare features of those who died in an acute hospital versus those who died at home.ResultsOf 143627 patients identified 40% (57678) died in an acute hospital, 29% (41957) died at home and 17% (24108) died in a hospice. Individual factors associated with death in an acute hospital bed compared to home were male sex, increasing age, poor performance status, social deprivation and diagnosis via an emergency route. There was marked variation between cancer Networks in place of death. The proportion of patients dying in an acute hospital ranged from 28% to 48%, with variation most notable in provision of hospice care (9% versus 33%). Cause of death in the majority was lung cancer (86%), with other malignancies, chronic obstructive pulmonary disease (COPD) and ischaemic heart disease (IHD) comprising 9% collectively.ConclusionsA substantial proportion of patients with lung cancer die in acute hospital beds and this is more likely with increasing age, male sex, social deprivation and in those with poor performance status. There is marked variation between Networks, suggesting a need to improve end-of-life planning in those at greatest risk, and to review the allocation of resources to provide more hospice beds, enhanced community support and ensure equal access.

Performance of care for end‐of‐life cancer patients in Tuscany: The interplay between place of care, aggressive treatments, opioids, and place of death. A retrospective cohort study

“…Finally, the findings on the potential predictors of dying in hospital are supported by previous evidence in terms of the role of hospices . Our data also show that hospital‐based cross‐setting care and pain management are key to a successful strategy for reducing the proportion of hospital deaths for advanced stage cancer patients.…”

“…Finally, the findings on the potential predictors of dying in hospital are supported by previous evidence in terms of the role of hospices. 41 Our data also show that hospital-based cross-setting care and pain management are key to a successful strategy for reducing the proportion of hospital deaths for advanced stage cancer patients. The findings confirm that the provision of aggressive care (ICU and chemotherapy) in the last stage of cancer is associated with negative outcomes such as dying in hospital.…”

Illness and end‐of‐life experiences of children with cancer who receive palliative care

“…Of additional interest is the negligible percentage of PPO patients who died in a hospice facility, which stands in contrast to adult oncology patients who die in greater numbers in hospice facilities . This finding likely speaks to a lack of hospice facilities with pediatric expertise in the United States .…”

“…Yet for the authors of this study, the high burden of PICU hos- Of additional interest is the negligible percentage of PPO patients who died in a hospice facility, which stands in contrast to adult oncology patients who die in greater numbers in hospice facilities. 69 This finding likely speaks to a lack of hospice facilities with pediatric expertise in the United States. 70,71 To date, only 14% of participating hospice agencies report having formal pediatric PC services with specialized staff, 71 and a number of educational, procedural, and sociocultural barriers further impede provision of community-based EOL care for children and families.…”

Dignity in dying

“…Należy uszanować wolę pacjenta, w szczególności co do miejsca umierania. Chociaż 65% chorych z nowotworem woli umierać w domu, w otoczeniu najbliższych [18], to większość zgonów następuje jednak w szpitalu [19]. Chęć ratowania życia za wszelką cenę narusza autonomię pacjenta i nie przynosi mu realnych korzyści.…”