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

ABSTRACT

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 non-hospital 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 types had higher risk of dying in hospice (1-4 rooms apartment RRR 1.13-3.17) or LTC (1-5 rooms apartment RRR 1.36-4.11); and those with Medifund usage had higher risk of dying in LTC (RRR 1.74; 95% CI 1.36-2.21). Patients with haematological malignancies had increased risk of dying in hospital (categories of haematological subtypes RRR 0.06-0.87). CONCLUSIONS: We found key sociodemographic and clinical factors associated with non-hospital deaths in cancer patients. More can be done to enable patients to die in the community and with dignity rather than in a hospital.