Places of Death from Cancer in a Rural Location

Abstract

Background: Most people would like to die at home, however, this wish still cannot be realized to any satisfactory extent. Provision of qualified palliative care can increase the death rate at home. Distribution of places of death of cancer patients in rural locations and possible factors influencing this distribution are still unknown. Patients and Methods: We retrospectively evaluated the data relating to death certificates of cancer patients issued between 1997 and 2003 by the administrative district ‘Sächsische Schweiz’. Results: In small-town and rural locations, the places of death from cancer were equally distributed among hospital and home. Patients living in a rural location and diagnosed as having breast cancer were more likely to die at home. Since 2001, the number of breast cancer patients dying at home has been increasing. Conclusions: Rural locations provide favorable conditions for home deaths. High therapy costs and transfer of expensive therapies away from hospitals into the outpatient therapy sector appear to have an effect on the place where patients are finally cared for and where they eventually die. This circumstance meets the wishes of most patients and leads to a relevant cost saving for the healthcare system. An effective and rigorous health and economic policy is necessary in order to realize an extensive home care for terminally ill patients.

Patients’ Choices of the Place of Their Death: A Complex, Culturally and Socially Charged Issue

“…Papke and Koch [1] in this issue of ONKOLOGIE raises many important questions and also stimulates our own existential reflection on how to define 'place of death'. Perhaps, we should start by asking why the subject is even worth discussing.…”

“…women with breast cancer during the periods 1997-2002 and 2002-2003, with particular emphasis on the role of economic factors [1]. However, the reasons for this temporal variability are likely to be much more complex.…”

“…A recent systematic review examined whether and how 'home' is a 'place of death' [4]. In analyzing Papke and Koch's conclusions that rural people tend to make the choice to die at home, we are faced with the question of what is home [1]. Is it a physical place or rather a 'familiarity', the presence of loved ones, normal life or perhaps the postponement of being confronted with death?…”

“…Papke and Koch describe possible reasons for the differences between the choices of Prof. Antonella Surbone MD PhD FACP European School of Oncology, via del Bollo 4 Milano, Italy E-mail asurbone@esoncology.org Cultural and generational differences also play a fundamental role, as elderly patients have been traditionally part of large family units, where care giving responsibilities were and still are effectively shared among all members [13]. To this effect, Papke and Koch mention the 'increased likelihood of a home death in rural areas … explained by the continued existence of the traditionally larger family unit…' [1]. However, the traditional rural area may have now become a place of high social mobility, where the younger generation is being drawn away from traditional norms of large and close-knit families towards a more isolated, vulnerable urban setting.…”

Ambulante palliativmedizinische Betreuung von Tumorpatienten

“…Im Home-Care-Modell kommt dem Onkologen eine Koordinatorenfunktion zu, da er den Patienten mit seiner Krankengeschichte lange kennt und die Notwendigkeiten der palliativmedizinischen Symptomkontrolle im Gespräch mit dem Home-Care-Arzt gut einschätzen kann. Der Beweis, dass dieses System viele Patienten in würdiger Situation bis zum Tod begleiten kann, ist hinlänglich erbracht[10][12][15].Für die Organisation von Palliativmedizin in einem Ballungsraum kann das Berliner Modell herangezogen werden. Die Bevölkerungsdichte in den Flächen-ländern lässt jedoch dessen Umsetzung in der Fläche nicht zu[7].…”