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Best place for cancer death—home

Posted by medconsumers on September 17, 2010

Which is the best place to die of cancer—home or hospital? This crucial question was answered in an unusual study that looked not only at the quality of remaining life for the dying cancer patients but also the impact on their loved ones.

Those who died in the hospital or an intensive care unit fared the worst in terms of physical and emotional distress, compared with those who died at home with hospice care. A hospital death also put the bereaved family members at a higher risk of depression, anxiety, and prolonged grief. Death in an ICU was associated with the highest risk of post-traumatic stress disorder—for the patients as well as the bereaved family members.

This study had an unexpected finding. The people who died at home without hospice care did the best in terms of quality of life and psychological well-being (better than home with hospice by about 1%, respectively). “This may be because they are a particularly well-adjusted group who either did not need additional services, had more family support, and/or received services we did not assess,” according to the researchers. As for the caregivers, the percentage who reported “stressful caregiving experiences” ranged from 5% (ICU)to nearly 8% (home with hospice).

This study was published recently in the Journal of Clinical Oncology and led by Alexi A. Wright, MD, Dana-Farber Cancer Institute, Boston. The researchers followed 342 patients for about 4 ½ months and their bereaved caregivers were assessed within two weeks of death. Caregivers were primarily spouses and adult children.

This type of study is long overdue because more and more people are treated aggressively, even when their cancers are advanced and there is little chance of prolonging life. The new study dovetails nicely with one published last month in the New England Journal of Medicine. It compared people with advanced lung cancer given either early palliative care or the standard aggressive treatment. Those given early palliative care received less aggressive care; reported a better quality of life; and had a longer survival.

When surveyed, most Americans say they want to die at home but most of us now die in hospitals. When faced with a cancer diagnosis, however, many might see the hospital as the better place for pain control. When Dr. Wright and colleagues were planning this new study, they wrote that were influenced by earlier research showing, “55% to 75% of cancer patients in an ICU reported moderate to severe pain, discomfort or anxiety, despite the routine integrations of palliative care services.”

Read “Americans are overtreated to death” in USA Today.

Maryann Napoli, Center for Medical Consumers©

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