Hospital Stay Did Not Improve Survival Among Terminal Cancer Patients in Japan

Hospital, hospice, or home—does the choice of site for patients at the end stage of their cancer significantly affect their survival and quality of life? According to a new study conducted in Japan, patients who chose to die at home had similar or even longer survival than those who chose to remain in a hospital.

More than 2000 Japanese patients were included in this prospective study, conducted between September 2012 and April 2014, among Japanese cancer patients receiving palliative care in the hospital (n = 1582) or at home (n = 487). The primary outcome to be valuated was the difference in survival between the 2 cohorts. While 1607 patients died in a hospital, 462 died at home. Importantly, survival among those who died at home was significantly longer than the survival of patients who died in the hospital, the authors report.

Among patients who had a survival prognosis of a few days, the estimated median survival for those who died at home was 13 days (95% CI, 10.3-15.7 days) while for those who died in the hospital, it was 9 days (95% CI, 8.0-10.0 days; P = .006). In the group with a prognosis in weeks, those who died at home had a median survival of 36 days (95% CI, 29.9-42.1 days), much longer than 29 days for those who died in the hospital (95% CI, 26.5-31.5 days; P = .007). However, the difference plateaued out in the group that had an estimated survival in months.

“The cancer patient and family tend to be concerned that the quality of medical treatment provided at home will be inferior to that given in a hospital and that survival might be shortened,” according to the study’s lead author Jun Hamano, MD, from the Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba. He said in a news release that their findings should help ease the concerns of patients and their families, in terms of choosing the site of death for the patient. “Patients, families, and clinicians should be reassured that good home hospice care does not shorten patient life, and even may achieve longer survival,” Hamano added.

Cost is a very important consideration in this discussion as well. The intensity of treatment provided to patients at the end of life can significantly increase healthcare costs. But this is improving, at least according to a recent study published in JAMA. The study, comparing the utilization of healthcare services and end-of-life costs among developed countries, found that the United States has the lowest proportion of deaths in the hospital and the lowest number of days in the hospital in the last 6 months of life among 7 developed countries that include Belgium, Canada, England, Germany, the Netherlands, Norway. This is a significant improvement compared with about 20 years back when more than one-fourth of Medicare’s budget was devoted to the care of patients with terminal illness who died in the hospital.

Reference

Hamano J, Yamaguchi T, Maeda I, et al. Multicenter cohort study on the survival time of cancer patients dying at home or in a hospital: does place matter [published online March 28, 2016]? Cancer. doi:10.1002/cncr.29844.