Dying at Home Did Not Hasten Death for Cancer Patients

Making the decision to die at home rather than in a hospital setting resulted in a similar or longer survival, according to the results of a study published in Cancer.

A Japanese study looking at place of death showed that patients with cancer who chose to die at home survived 4 days to a week longer than those patients who died in a hospital.

“Our findings demonstrate that home death does not have a negative influence on the survival of cancer patients,” wrote researcher Jun Hamano, MD, of the University of Tsukuba, Japan, and colleagues. “Thus, the noninferiority of the survival time for patients dying at home suggests that an oncologist should not hesitate to refer patients for home-based palliative care simply because less medical treatment may be provided.”

Hamano and colleagues conducted a multicenter study that included 58 specialist palliative care services based in Japan between 2012 and 2014. The study included 2,069 patients, of whom 487 received home-based palliative care services.

Of the 1,582 patients assigned hospital-based care included in the study, 1,507 died in the hospital and 75 died at home; of the 487 assigned home-based care, 387 died at home and 100 died at the hospital.

The researchers looked at patients given days, weeks, or months to live. Both groups of patients who died at home had significantly longer survival time than those who died in the hospital. For patients with just days’ prognosis, the median survival time at home was 13 days compared with 9 days in the hospital (P = .006). For patients with weeks’ prognosis, the median survival time was 36 days at home compared with 29 days in the hospital (P = .007). No significant difference in survival was found for patients who were given months to live.

Similarly, patients with days’ prognosis who received home-based palliative care had longer survival times compared with those who received hospital-based care (13 vs 10 days; P = .039), but no significant difference was found between the groups for patients with weeks’ prognosis (34 vs 29 days).

“Although patients with home deaths and home-based palliative care had similar or significantly longer survival in comparison with patients with hospital deaths and hospital-based palliative care, it is interesting that life-sustaining treatment (parenteral hydration and antibiotics) was provided for a significantly higher percentage of patients with hospital deaths and hospital-based palliative care,” the researchers noted. “A possible reason for the finding that home death had no measurable negative influence on survival despite less use of parenteral hydration and antibiotics is that these treatments were not effective for prolonging survival in the patient population of this study.”

In their discussion of the results, Hamano and colleagues acknowledged that patients referred for home-based palliative care may be inherently different than those who died in the hospital, and that not all confounding factors could be adjusted for.

“To confirm whether the place of death influences the survival time, a randomized controlled trial is the most robust type of clinical research, but randomizing the place of death is practically impossible and unethical,” the researchers wrote. “Therefore, well-designed observational studies that compare survival by matching patient background factors can provide the best available evidence.”