Intensity of Care, Expenditure, and Place of Death in French Women in the Year Before Their Death From Breast Cancer: A Population-Based Study

Health care utilization of women with breast cancer (BC) during the last year of life, together with the causes and place of death and associated expenditure have been poorly described. Women treated for BC (2014-2015) with BC as a cause of death in 2015 and covered by the national health insurance general scheme (77% of the population) were identified in the French health data system (n = 6,696, mean age: 68.7 years, SD ± 15). Almost 70% died in short-stay hospitals (SSH), 4% in hospital-at-home (HaH), 9% in Rehab, 5% in skilled nursing homes (SNH) and 12% at home. One-third presented cardiovascular comorbidity. During the last year, 90% were hospitalized at least once in SSH, 25% in Rehab, 13% in HaH and 71% received hospital palliative care (HPC), but only 5% prior to their end-of-life stay. During the last month, 85% of women were admitted at least once to a SSH, 42% via the emergency department, 10% to an ICU, 24% received inpatient chemotherapy and 18% received outpatient chemotherapy. Among the 83% of women who died in hospital, independent factors for HPC use were cardiovascular comorbidity (adjusted odds ratio, aOR: 0.83; 95%CI: 0.72–0.95) and, in the 30 days before death, at least one SNH stay (aOR: 0.52; 95%CI: 0.36-0.76), ICU stay (aOR: 0.36; 95%CI: 0.30-0.43), inpatient chemotherapy (aOR: 0.55; 95%CI: 0.48-0.63), outpatient chemotherapy (aOR: 0.60; 95%CI: 0.51-0.70), death in Rehab (aOR: 1.4; 95%CI: 1.05-1.86) or HAH (aOR: 4.5; 95%CI: 2.47-8.1) vs SSH. Overall mean expenditure reimbursed per woman was €38,734 and €42,209 for those with PC. Women with inpatient or outpatient chemotherapy during the last month had lower rates of HPC, suggesting declining use of HPC before death. This study also indicates SSH-centered management with increased use of HPC in HaH and Rehab units and decreased access to HPC in SNH.

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Where Patients With Cancer Die: A Population-Based Study, 1990 to 2012

Journal of Palliative Care ◽

10.1177/0825859718814813 ◽

2018 ◽

Vol 34 (4) ◽

pp. 224-231 ◽

Cited By ~ 1

Author(s):

Roger W. Hunt ◽

Katina D’Onise ◽

Anh-Minh Thi Nguyen ◽

Kamalesh Venugopal

Keyword(s):

Palliative Care ◽

Nursing Homes ◽

Care Delivery ◽

Young Patients ◽

Population Based ◽

Place Of Death ◽

Patients With Cancer ◽

Metropolitan Hospital ◽

Care Models ◽

At Home

Aims:To describe changes in the place of death of patients with cancer from 1990 to 2012, and to identify issues for their end-of-life care.Materials and Methods:Population-based descriptive study, with analyses of place of death patterns, using the South Australian Cancer Registry records of 86 257 patients with cancer who died from 1990 to 2012.Results:From 1990 to 2012, the proportion of cancer deaths in hospital decreased from 63.4% to 50.9%, and in nursing homes increased from 8.2% to 22.5%. After the year 2000, the proportions in hospices and at home were both below 15%. Multivariate analyses showed that young patients with cancer were more likely to die in a hospice or at home, compared to elderly patients with cancer who were more likely to die in a nursing home; the likelihood of dying in a hospice increased with socioeconomic status; patients with a short survival time or a hematological malignancy were more likely to die in a metropolitan hospital.Conclusions:Compared to most other countries, the proportion of cancer deaths at home was low, and many patients would not have died at their preferred place. The trend for more cancer deaths to occur in nursing homes is likely to continue, but nursing homes generally lack the resources and skilled staff to provide quality palliative care. Models of palliative care delivery should take account of patient preferences, the growth of terminal cancer care in nursing homes, and apparent inequities.

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Predictors of Place of Death for Seniors in Ontario: A Population-Based Cohort Analysis

Canadian Journal on Aging / La Revue canadienne du vieillissement ◽

10.1353/cja.2007.0019 ◽

2006 ◽

Vol 25 (4) ◽

pp. 363-371 ◽

Cited By ~ 28

Author(s):

Sanober S. Motiwala ◽

Ruth Croxford ◽

Denise N. Guerriere ◽

Peter C. Coyte

Keyword(s):

Home Care ◽

Economic Status ◽

Cohort Analysis ◽

Care Facility ◽

Multinomial Logit Model ◽

Population Based ◽

Place Of Death ◽

Fiscal Year ◽

Term Care ◽

At Home

ABSTRACTPlace of death was determined for all 58,689 seniors (age ≥ 66 years) in Ontario who died during fiscal year 2001/2002. The relationship of place of death to medical and socio-demographic characteristics was examined using a multinomial logit model. Half (49.2%) of these individuals died in hospital, 30.5 per cent died in a long-term care facility, 9.6 per cent died at home while receiving home care, and 10.7 per cent died at home without home care. Co-morbidities were the strongest predictors of place of death (p< 0.0001). A cancer diagnosis increased the chances of death at home while receiving home care; seniors with dementia were most likely to die in LTC facilities; and those with major acute conditions were most likely to die in hospitals. Higher socio-economic status was associated with greater probability of dying at home but contributed little to the model. Appropriate planning and resource allocation may help move place of death from hospitals to nursing homes or the community, in accordance with individual preferences.

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Predictors of Death at Home Among Cancer Patients in Israel: A Population-based Study

10.21203/rs.3.rs-87269/v1 ◽

2020 ◽

Author(s):

Yakir Rottenberg ◽

Gil Goldzweig ◽

Adir Shaulov

Keyword(s):

Cancer Patients ◽

Binary Logistic Regression ◽

Hematologic Malignancies ◽

Population Based ◽

Place Of Death ◽

Personal Factors ◽

Low Socioeconomic ◽

Predictive Variables ◽

Dying At Home ◽

At Home

Abstract Background: Most cancer patients want to die at home; however, many die in hospital. The aim of the current study is to elucidate the correlation between dying at home and various personal factors in the Israeli population of cancer patients.Methods: Data on cancer incidence (2008-2015) and death (2008-2017) was provided by the Israeli Central Bureau of Statistics and the Israel National Cancer Registry. Binary logistic regression analyses were performed to assess odds ratios for death at home following cancer diagnosis while controlling for age, sex, ethnicity, years of education, residential socioeconomic score, and time from diagnosis. We also assessed the relation between place of death and specific cancer sites, as well as the time trend from 2008-2017.Results: About one quarter (26.7%) of the study population died at home. Death at home was most frequent among patients diagnosed with brain tumors (37.0%), while it was the lowest among patients with hematologic malignancies (lymphoma and leukemia, 20.3% and 20.0%, respectively). Rates of dying at home among patients with residential socioeconomic scores of 1, 2-9, and 10 were about 15%, 30%, and 42.9%, respectively. In patients from the 4th to the 7th decades of life, rates of death at home increased at a linear rate that increased exponentially from the 8th decade onwards. After controlling for potential confounders, predictive variables for death at home included age (HR=1.020 per year), male sex (HR=1.18), years of education (HR=1.029 per year), and time from diagnosis (HR=1.003 per month, all p<0.001). No trend was seen from 2008-2013, while from 2014-2017 a slight increase in the rate of death at home was seen each year.Conclusions: These results indicate that inequality exists among cancer patients in Israel regarding the opportunity to die at home. The present findings stress the importance of delivering efficient palliative care at home, mainly for patients with hematologic malignancies, younger patients, and patients of very low socioeconomic statuses. Understanding the complex mechanisms whereby patient preferences and the above variables may determine the preferred place of death remains an important research priority.

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Place of death and associated factors: a population-based study using death certificate data

European Journal of Public Health ◽

10.1093/eurpub/cky267 ◽

2019 ◽

Vol 29 (4) ◽

pp. 608-615 ◽

Cited By ~ 6

Author(s):

María José Cabañero-Martínez ◽

Andreu Nolasco ◽

Inmaculada Melchor ◽

Manuel Fernández-Alcántara ◽

Julio Cabrero-García

Keyword(s):

Marital Status ◽

Cause Of Death ◽

Death Certificate ◽

Population Based ◽

Place Of Death ◽

Population Based Study ◽

Urbanization Level ◽

Sociodemographic Variables ◽

Death Certificate Data ◽

At Home

Abstract Background Although studies suggest that most people prefer to die at home, not enough is known about place of death patterns by cause of death considering sociodemographic factors. The objective of this study was to determine the place of death in the population and to analyze the sociodemographic variables and causes of death associated with home as the place of death. Methods Cross-sectional population-based study. All death certificate data on the residents in Spain aged 15 or over who died in Spain between 2012 and 2015 were included. We employed multinomial logistic regression to explore the relation between place of death, sociodemographic variables and cause of death classified according to the International Classification of Diseases, 10th revision, and to conditions needing palliative care. Results Over half of all deaths occurred in hospital (57.4%), representing double the frequency of deaths that occurred at home. All the sociodemographic variables (sex, educational level, urbanization level, marital status, age and country of birth) were associated with place of death, although age presented the strongest association. Cause of death was the main predictor with heart disease, neurodegenerative disease, Alzheimer’s disease, dementia and senility accounting for the highest percentages of home deaths. Conclusions Most people die in hospital. Cause of death presented a stronger association with place of death than sociodemographic variables; of these latter, age, urbanization level and marital status were the main predictors. These results will prove useful in planning end-of-life care that is more closely tailored to people’s circumstances and needs.

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Impact of Baseline Cardiovascular Comorbidity on Outcomes in Women With Breast Cancer: A Real-world, Population-based Study

Clinical Breast Cancer ◽

10.1016/j.clbc.2018.12.005 ◽

2019 ◽

Vol 19 (2) ◽

pp. e297-e305 ◽

Cited By ~ 1

Author(s):

Omar Abdel-Rahman ◽

Yuan Xu ◽

Shiying Kong ◽

Joseph Dort ◽

May Lynn Quan ◽

...

Keyword(s):

Breast Cancer ◽

Real World ◽

Population Based ◽

World Population ◽

Population Based Study ◽

Cardiovascular Comorbidity

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Identification in Administrative Databases of Women Dying of Breast Cancer

Journal of Clinical Oncology ◽

10.1200/jco.2005.02.1790 ◽

2006 ◽

Vol 24 (6) ◽

pp. 856-862 ◽

Cited By ~ 19

Author(s):

Bruno Gagnon ◽

Nancy E. Mayo ◽

Carroll Laurin ◽

James A. Hanley ◽

Neil McDonald

Keyword(s):

Breast Cancer ◽

Health Services ◽

Predictive Value ◽

Chronic Care ◽

Chart Review ◽

Population Based ◽

Place Of Death ◽

Administrative Databases ◽

Services Research

Purpose Palliative care is an essential component of cancer care, and population-based research is needed to monitor its impact. Administrative databases are the cornerstone of health services research. Their limitation is that cause of death is not sufficient to readily classify decedents as terminally ill for the study of the health services they received at the end of life. The study purpose is to develop and test the validity of an algorithm allowing the classification of the decedents as dying of breast cancer (BC), using administrative data. Methods Validation was carried out through a chart review of 119 BC decedents extracted from hospital-based databases. This algorithm was applied to 3,384 deceased women with BC representative of the whole population. The effect of the classification by the algorithm was illustrated by the shift in the distributions of age and place of death. Results The validation showed a sensitivity of 95%, a specificity of 89%, a positive predictive value of 98%, and negative predictive value of 77% for the classification of women dying of BC. Of the 3,384 decedents, 2,293 were classified as dying of, and 1,091 as not dying of BC. Women dying of BC were younger, died less often at home (6.9% v 17.9%), and in chronic care institutions (4.1% v 14.8%), and more often in acute-care beds (69.9% v 57.1%). Conclusion This novel way to classify decedents is conceptually based and empirically validated through chart review and impact on distribution of age and place of death.

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Insights into the factors associated with achieving the preference of home death in terminal cancer: A national population-based study

Palliative & Supportive Care ◽

10.1017/s1478951517000876 ◽

2017 ◽

Vol 16 (6) ◽

pp. 749-755 ◽

Cited By ~ 6

Author(s):

Finian Bannon ◽

Victoria Cairnduff ◽

Deirdre Fitzpatrick ◽

Janine Blaney ◽

Barbara Gomes ◽

...

Keyword(s):

Cancer Patients ◽

Population Based ◽

Postal Questionnaire ◽

Place Of Death ◽

Home Death ◽

District Nurse ◽

Terminally Ill Cancer Patients ◽

Factors Associated ◽

Dying At Home ◽

At Home

ABSTRACTObjectives:Most terminally ill cancer patients prefer to die at home, yet only a minority are able to achieve this. Our aim was to investigate the factors associated with cancer patients achieving their preference to die at home.Methods:This study took the form of a mortality followback, population-based, observational survey of the relatives of deceased cancer patients in Northern Ireland. Individuals who registered the death of a friend or relative (aged ≥ 18 years) between 1 December 2011 and 31 May 2012, where the primary cause of death was cancer (ICD10: C00–D48), who were invited to take part. Preferred and actual place of death, and patient, service, and clinical data were collected using the QUALYCARE postal questionnaire. Multivariable logistic regression was employed to investigate the factors associated with achieving a home death when preferred.Results:Some 467 of 1,493 invited informants completed the survey. The 362 (77.5%) who expressed a preference for dying at home and spent time at home in their final 3 months were included in our analysis. Of these, 53.4% achieved their preference of a home death. Factors positively associated with achieving a home death were: living in an affluent area, receipt of good and satisfactory district nurse care, discussing place of death with health professionals, and the caregiver's preference for a home death. Being older than 80 years of age, being a Presbyterian, and being unconscious most of the time during their final week were negatively associated with achieving a home death.Significance of Results:Communication, care satisfaction, and caregiver preferences were all associated with home death. Our findings will help inform the design of future interventions aimed at increasing the proportion of patients achieving their preferred place of death at home, for example, by targeting interventions toward older patients and those from the most deprived communities.

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Predictors of death at home among cancer patients in Israel: a population-based study

International Journal for Equity in Health ◽

10.1186/s12939-021-01437-y ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Yakir Rottenberg ◽

Gil Goldzweig ◽

Adir Shaulov

Keyword(s):

Socioeconomic Status ◽

Cancer Patients ◽

Sex Education ◽

Low Socioeconomic Status ◽

Hematologic Malignancies ◽

Population Based ◽

Place Of Death ◽

Personal Factors ◽

Dying At Home ◽

At Home

Abstract Background Most cancer patients prefer to die at home; however, many die in hospital. The aim of the current study is to elucidate the association between dying at home and various personal factors in the Israeli population of cancer patients. Methods Data on cancer incidence (2008–2015) and death (2008–2017) was provided by the Israeli Central Bureau of Statistics and the Israel National Cancer Registry. Binary logistic regression analyses were performed to assess odds ratios for death at home following cancer diagnosis while controlling for age, sex, ethnicity, years of education, residential socioeconomic score, and time from diagnosis. We also assessed the relation between place of death and specific cancer sites, as well as the time trend from 2008 to 2017. Results About one quarter (26.7%) of the study population died at home. Death at home was most frequent among patients diagnosed with brain tumors (37.0%), while it was the lowest among patients with hematologic malignancies (lymphoma and leukemia, 20.3 and 20.0%, respectively). Rates of dying at home among patients with residential socioeconomic scores of 1, 2–9, and 10 were about 15, 30, and 42.9%, respectively. In patients from the 4th to the 7th decades of life, rates of death at home increased at a linear rate that increased exponentially from the 8th decade onwards. After controlling for potential confounders, predictive variables for death at home included age (OR = 1.020 per year, 95% CI 1.017–1.024), male sex (OR = 1.18, 95% CI 1.077–1.294), years of education (OR = 1.029 per year, 95% CI 1.018–1.040), and time from diagnosis (OR = 1.003 per month, 95% CI 1.001–1.005 all p < 0.001). No trend was seen from 2008 to 2013, while from 2014 to 2017 a slight increase in the rate of death at home was seen each year. Conclusions These results indicate wide variability in death at home exists among patients of different ages, sex, education, socioeconomic status and time from diagnosis. These findings stress the importance of delivering quality palliative care at home, mainly for patients with hematologic malignancies, younger patients, and patients of very low socioeconomic status. Understanding the complex mechanisms whereby patient preferences and the above variables may determine the preferred place of death remains an important research priority.

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Predictors of death at home among cancer patients in Israel: A population-based study

10.21203/rs.3.rs-87269/v2 ◽

2021 ◽

Author(s):

Yakir Rottenberg ◽

Gil Goldzweig ◽

Adir Shaulov

Keyword(s):

Socioeconomic Status ◽

Cancer Patients ◽

Sex Education ◽

Low Socioeconomic Status ◽

Hematologic Malignancies ◽

Population Based ◽

Place Of Death ◽

Personal Factors ◽

Dying At Home ◽

At Home

Abstract Background: Most cancer patients prefer to die at home; however, many die in hospital. The aim of the current study is to elucidate the association between dying at home and various personal factors in the Israeli population of cancer patients.Methods: Data on cancer incidence (2008-2015) and death (2008-2017) was provided by the Israeli Central Bureau of Statistics and the Israel National Cancer Registry. Binary logistic regression analyses were performed to assess odds ratios for death at home following cancer diagnosis while controlling for age, sex, ethnicity, years of education, residential socioeconomic score, and time from diagnosis. We also assessed the relation between place of death and specific cancer sites, as well as the time trend from 2008-2017.Results: About one quarter (26.7%) of the study population died at home. Death at home was most frequent among patients diagnosed with brain tumors (37.0%), while it was the lowest among patients with hematologic malignancies (lymphoma and leukemia, 20.3% and 20.0%, respectively). Rates of dying at home among patients with residential socioeconomic scores of 1, 2-9, and 10 were about 15%, 30%, and 42.9%, respectively. In patients from the 4th to the 7th decades of life, rates of death at home increased at a linear rate that increased exponentially from the 8th decade onwards. After controlling for potential confounders, predictive variables for death at home included age (OR=1.020 per year, 95% CI 1.017-1.024), male sex (OR=1.18, , 95% CI 1.077-1.294), years of education (OR=1.029 per year, 95% CI 1.018-1.040), and time from diagnosis (OR=1.003 per month, 95% CI 1.001-1.005 all p<0.001). No trend was seen from 2008-2013, while from 2014-2017 a slight increase in the rate of death at home was seen each year.Conclusions: These results indicate wide variability in death at home exists among patients of different ages, sex, education, socioeconomic status and time from diagnosis. These findings stress the importance of delivering quality palliative care at home, mainly for patients with hematologic malignancies, younger patients, and patients of very low socioeconomic status. Understanding the complex mechanisms whereby patient preferences and the above variables may determine the preferred place of death remains an important research priority.

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Trends in place of death: The role of demographic and epidemiological shifts in end-of-life care policy

Palliative Medicine ◽

10.1177/0269216317691259 ◽

2017 ◽

Vol 31 (10) ◽

pp. 964-974 ◽

Cited By ~ 32

Author(s):

Jorid Kalseth ◽

Ole Magnus Theisen

Keyword(s):

Cause Of Death ◽

Population Based ◽

Place Of Death ◽

Joinpoint Regression ◽

Observation Study ◽

Hospital Nursing ◽

Epidemiological Changes ◽

Causes Of Mortality ◽

Using Data ◽

At Home

Background: Surveys suggest that most people prefer to die at home. Trends in causes of mortality and age composition could limit the feasibility of home deaths. Aim: To examine the effect of changes in decedents’ age, gender and cause of death on the pattern of place of death using data on all deaths in Norway for the period 1987–2011. Design: Population-based observation study comparing raw, predicted, as well as standardised shares of place of death isolating the effect of demographic and epidemiological changes. The analysis was bolstered with joinpoint regression to detect shifts in trends in standardised shares. Setting/participants: All deaths (1,091,303) in Norway 1987–2011 by age, gender and cause of death. Place of death at home, hospital, nursing home and other. Results: Fewer people died in hospitals (34.1% vs 46.2%) or at home (14.2% vs 18.3%), and more in nursing homes (45.5% vs 29.5%) in 2011 than in 1987. Much of the trend can be explained by demographic and epidemiological changes. Ageing of the population and the epidemiological shift represented by the declining share of deaths from circulatory diseases (31.4% vs 48.4%) compared to the increase in deaths from neoplasms (26.9% vs 21.8%) and mental/behavioural diseases (4.4% vs 1.2%) are the strongest drivers in the shift in place of death. Joinpoint regression shows important differences between categories. Conclusion: Demographic and epidemiological changes go a long way in explaining shifts in place of death. The analyses reveal substantial differences in trends between different decedent groups.

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