Symptom Prevalence and Place of Death Preference in Advanced Cancer Patients: Factors Associated With the Achievement of Home Death

Abstract

Objectives: Achievement of patients' preferred place of death is recognized as a component of a good death. This study aimed to investigate the symptom burden in advanced cancer patients, achievement of their place of death preferences and factors associated with home death.

Methods: In this retrospective review of 287 patient deaths, we examined patients' symptom prevalence, preferred and actual place of death and achievement of their place of death preferences using descriptive statistics. Associations between patient factors, home death preference and actual home death were further analyzed using multivariate logistic regression.

Results: The most prevalent symptoms were weakness, pain and poor appetite, with a mean of 5.77(SD: 2.37) symptoms per patient. The median interval from palliative care referral to death was 21 (IQR: 74) days. Of the 253 patients with documented place of death preference, 132 (52.1%) preferred home death, 111(43.9%) preferred hospital death, 1 (0.4%) preferred to die at a temple and 9(3.6%) expressed no preference. Overall, 221 of 241(91.7%) patients with known actual place of death achieved their preference. Older patients were more likely to prefer home death (OR 1.021; 95% CI 1.004-1.039, p = 0.018) and die at home (OR 1.023; 95% CI 1.005-1.041, p = 0.014). Gender, marital status, cancer diagnosis and symptoms were not associated with preference for or actual home death.

Conclusion: Despite a high symptom burden, most patients preferred and achieved a home death. Late palliative care referral and difficult symptom management contributed to failure to fulfill home death preference. Preference for home death should be considered when managing terminally ill geriatric patients.

Keywords: cancer; geriatrics; home death; palliative care; place of death preference; symptom.

Figure 1.

Distribution of cancer diagnoses in patients who passed away under the care of the palliative care unit (n = 287). *Three patients had 2 concurrent tumors, 1 had 3 concurrent malignancies. GIST indicates gastrointestinal stromal tumor.

Figure 2.

Indications for palliative care referral. *There was incomplete data for 6 patients, thus these patients were excluded from analysis.

Figure 3.

Symptom prevalence observed at first palliative care consultation. *Six patients were excluded due to incomplete data on symptom prevalence.

Figure 4.

Comparison between preferred and actual place of death and achievement of preferred place of death. (a) 34 of 287 patients were excluded (9 patients were lost to follow-up, 13 were transferred to another center, and 12 deteriorated acutely before preferences regarding place of death could be established). (b) 9 of 253 patients who expressed no preference for place of death were excluded. (c) 12 of 253 patients were excluded (9 patients with no preference for place of death, and 3 who were lost to follow-up).