PREDICTORS OF HOME DEATH IN PATIENTS WITH TERMINAL LUNG CANCER: A SINGLE-CENTRE RETROSPECTIVE STUDY FOR THE REGIONAL ALLIANCE

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Abstract

Background

Cancer is the leading cause of death in Japan. Recently, the number of patients with lung cancer has been increasing. Most terminal cancer patients wish to die at home, but in fact, most nevertheless die in a hospital. The place of death is important to many patients, and home death may be best in terms of the patients' QOL, family satisfaction, and also regarding the overall cost.

Purpose

We retrospectively clarified the predictors of home deaths in terminal lung cancer patients. [Patients and Methods] We examined the patients with lung cancer who were introduced to about 30 home palliative care clinics between January 2009 and March 2010. We collected various data from their clinical records as follows; baseline demographics information including sex, PS, stage, and histology, patient's symptoms, patient's desire for home death, the family's wish for the patient's home death, the main caregivers, the number of caregivers, and the presence of a central vein access port (CV port). The survival time and the period of home palliative care were defined as the time from the first visit by the home palliative care team to the date of death, and the period of time after subtracting the total duration of hospitalization from the survival time, respectively. We confirmed the date of home death by a questionnaire given to the home palliative clinics.

Results

Ninety-one patients were introduced to home palliative care between 1 January 2009 and 31 March 2010, and 78 of them died of lung cancer. Of these 78 patients, 31 died at home (39.7%) and 47 died in a hospital. There were no significant differences in the median survival time between the group of subjects who died in a hospital (53 days) and those who died at home (50 days), and the period of home palliative care in the former (36 days) tended to be shorter than that in the later (50 days). According to a multivariate analysis, the patient's desire for home death and the presence of a CV port were significant factors associated with home death (P = 0.001 and P = 0.041, respectively).

Conclusion

The patient's desire for home death and the use of a CV port may therefore promote home death in terminal lung cancer patients.

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