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Going back to home to die: does it make a difference to patient survival?

Murakami N, Tanabe K, Morita T, Kadoya S, Shimada M, Ishiguro K, Endo N, Sawada K, Fujikawa Y, Takashima R, Amemiya Y, Iida H, Koseki S, Yasuda H, Kashii T - BMC Palliat Care (2015)

Bottom Line: Median survival adjusted for propensity score was significantly longer in the home care group (67.0 days, n = 69) than in the hospital care group (33.0 days, n = 69; P = 0.0013).Cox's proportional hazard analysis revealed that the place of care was a significant factor for survival following adjustment for covariates including performance status.A cohort study including more known prognostic factors is necessary to confirm the results.

View Article: PubMed Central - PubMed

Affiliation: Home Palliative Care Committee, Takaoka Medical Service Region, 387-1 Futatsuka, Takaoka, Toyama 933-0816 Japan.

ABSTRACT

Background: Many patients wish to stay at home during the terminal stage of cancer. However, there is concern that medical care provided at home may negatively affect survival. This study therefore explored whether the survival duration differed between cancer patients who received inpatient care and those who received home care.

Methods: We retrospectively investigated the place of care/death and survival duration of 190 cancer patients after their referral to a palliative care consultation team in a Japanese general hospital between 2007 and 2012. The patients were classified into a hospital care group consisting of those who received palliative care in the hospital until death, and a home care group including patients who received palliative care at home from doctors in collaboration with the palliative care consultation team. Details of the place of care, survival duration, and patient characteristics (primary site, gender, age, history of chemotherapy, and performance status) were obtained from electronic medical records, and analyzed after propensity score matching in the place of care.

Results: Median survival adjusted for propensity score was significantly longer in the home care group (67.0 days, n = 69) than in the hospital care group (33.0 days, n = 69; P = 0.0013). Cox's proportional hazard analysis revealed that the place of care was a significant factor for survival following adjustment for covariates including performance status.

Conclusions: This study suggests that the general concern that home care shortens the survival duration of patients is not based on evidence. A cohort study including more known prognostic factors is necessary to confirm the results.

No MeSH data available.


Related in: MedlinePlus

Kaplan–Meier curves for adjusted overall survival duration of propensity-matched patients stratified according to the settings of palliative care. The median overall survival times were 33.0 and 67.0 days for patients in hospital and home care, respectively.
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Fig1: Kaplan–Meier curves for adjusted overall survival duration of propensity-matched patients stratified according to the settings of palliative care. The median overall survival times were 33.0 and 67.0 days for patients in hospital and home care, respectively.

Mentions: The log-rank test showed that matched patient survival time was significantly longer in the home care group (home care group: median, 67.0 days, range, 35–115 days vs. hospital care group: median, 33.0 days, range, 15–72 days, P = 0.0013; Figure 1). Cox’s proportional hazard analysis revealed that the place of care was a significant factor in predicting patient survival in all models (Table 3).Figure 1


Going back to home to die: does it make a difference to patient survival?

Murakami N, Tanabe K, Morita T, Kadoya S, Shimada M, Ishiguro K, Endo N, Sawada K, Fujikawa Y, Takashima R, Amemiya Y, Iida H, Koseki S, Yasuda H, Kashii T - BMC Palliat Care (2015)

Kaplan–Meier curves for adjusted overall survival duration of propensity-matched patients stratified according to the settings of palliative care. The median overall survival times were 33.0 and 67.0 days for patients in hospital and home care, respectively.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4376364&req=5

Fig1: Kaplan–Meier curves for adjusted overall survival duration of propensity-matched patients stratified according to the settings of palliative care. The median overall survival times were 33.0 and 67.0 days for patients in hospital and home care, respectively.
Mentions: The log-rank test showed that matched patient survival time was significantly longer in the home care group (home care group: median, 67.0 days, range, 35–115 days vs. hospital care group: median, 33.0 days, range, 15–72 days, P = 0.0013; Figure 1). Cox’s proportional hazard analysis revealed that the place of care was a significant factor in predicting patient survival in all models (Table 3).Figure 1

Bottom Line: Median survival adjusted for propensity score was significantly longer in the home care group (67.0 days, n = 69) than in the hospital care group (33.0 days, n = 69; P = 0.0013).Cox's proportional hazard analysis revealed that the place of care was a significant factor for survival following adjustment for covariates including performance status.A cohort study including more known prognostic factors is necessary to confirm the results.

View Article: PubMed Central - PubMed

Affiliation: Home Palliative Care Committee, Takaoka Medical Service Region, 387-1 Futatsuka, Takaoka, Toyama 933-0816 Japan.

ABSTRACT

Background: Many patients wish to stay at home during the terminal stage of cancer. However, there is concern that medical care provided at home may negatively affect survival. This study therefore explored whether the survival duration differed between cancer patients who received inpatient care and those who received home care.

Methods: We retrospectively investigated the place of care/death and survival duration of 190 cancer patients after their referral to a palliative care consultation team in a Japanese general hospital between 2007 and 2012. The patients were classified into a hospital care group consisting of those who received palliative care in the hospital until death, and a home care group including patients who received palliative care at home from doctors in collaboration with the palliative care consultation team. Details of the place of care, survival duration, and patient characteristics (primary site, gender, age, history of chemotherapy, and performance status) were obtained from electronic medical records, and analyzed after propensity score matching in the place of care.

Results: Median survival adjusted for propensity score was significantly longer in the home care group (67.0 days, n = 69) than in the hospital care group (33.0 days, n = 69; P = 0.0013). Cox's proportional hazard analysis revealed that the place of care was a significant factor for survival following adjustment for covariates including performance status.

Conclusions: This study suggests that the general concern that home care shortens the survival duration of patients is not based on evidence. A cohort study including more known prognostic factors is necessary to confirm the results.

No MeSH data available.


Related in: MedlinePlus