Home Hospice Cancer Deaths Easier on Patients, Caregivers

Patients have better end-of-life quality, caregivers less psychiatric illness
By Lindsey Marcellin
HealthDay Reporter

TUESDAY, Sept. 14 (HealthDay News) -- Terminal cancer patients who die in the hospital have higher distress levels and worse quality of life (QoL) at the end of life (EOL) than those who die at home with hospice care, and their bereaved caregivers are more likely to experience psychiatric illness, according to research published online Sept. 13 in the Journal of Clinical Oncology.

Alexi A. Wright, M.D., of the Dana-Farber Cancer Institute in Boston, and colleagues conducted a prospective, longitudinal, multi-site study of patients with advanced cancer and their caregivers (342 dyads) to assess whether the place of death was associated with patients' QoL at the EOL and psychiatric disorders in their grieving caregivers. Patients' QoL at the EOL was assessed by the caregivers within two weeks of death; caregivers' mental health was assessed at baseline and six months after loss with structured interviews.

The researchers found that patients who died in the hospital had significantly more distress -- physical as well as emotional -- and worse QoL at the EOL than those who died at home with hospice care. Caretakers of patients who died in the intensive care unit had an adjusted odds ratio of 5.0 for posttraumatic stress disorder compared to caretakers of patients who died at home with hospice. Caretakers of patients with hospital deaths also had a higher risk (adjusted odds ratio, 8.83) for prolonged grief disorder.

"These findings are important because patients with advanced cancer are receiving increasingly aggressive care at the EOL," the authors write. "Interventions aimed at reducing terminal hospitalizations or increasing the utilization of hospice services may improve the QoL of patients with advanced cancer at the EOL and reduce the risk of psychiatric illness in bereaved caregivers."

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