Though research suggests that most people prefer a home death, a new study from ICES, McMaster University and Bruyère Research Institute finds that people dying of cancer spent most of their final days in either health care institutions or at home without any health care supports.
The last 100 days of life for people dying of cancer is a time marked by increasing healthcare use and costs, as patients can face aggressive treatments and often suffer with severe pain.
The study, published in Cancer Medicine, set out to describe the different settings of care that Ontario patients access when dying of cancer, including emergency department, inpatient hospital, palliative care units, complex continuing care or rehabilitation, long-term care, and days in the community. The researchers found that people spent 26 days on average in health care institutions, 26 days in the community receiving care at their doctor’s office or from home care services, and 48 days at home not receiving any care.
“Research shows that patients dying of cancer wish to maintain their independence and autonomy and most indicate they prefer a home death,” says lead author Abe Hafid, statistical analyst at the Department of Family Medicine at McMaster University. “Although not all patients will want to die at home, our study suggests that there could be a mismatch between people’s preferences and the care they actually receive at the end of their life.”
The study included 125,755 people who died of cancer in Ontario between January 1, 2013, and December 31, 2017 and found that:
- People increasingly spent more time in health care institutions as they approached death (6 days/week on average at home and 1 day/week in a health care institution 14 weeks before death; and 3 days/week on average at home and 4 days/week in a health care institution in the last week of life).
- 24% died of lung cancer, 7% breast cancer, 7% colorectal cancer, 7% pancreatic cancer, 5% prostate and 50% were other types of cancer.
- People with aggressive cancers (e.g. pancreatic and lung) spent fewer days in institutions than those with less aggressive cancers (e.g., breast, colorectal).
Though differences were marginal, a general pattern showed that as neighbourhood income increased, patients spent fewer days in institutions and more days at home. People of the lowest neighbourhood income spent fewer days at home with home care than people of the highest neighbourhood income—a resource which ideally would not vary based on income in a universal healthcare system.
“We need to better support patients with cancer to communicate their care preferences and accordingly deliver goal-concordant care,” says senior author Dr. Sarina Isenberg, Bruyère Chair in Mixed Methods Palliative Care Research at the Bruyère Research Institute, and assistant professor in the Department of Medicine at the University of Ottawa. “As well, these findings point the need for more publicly-provided home-based and community-based palliative care services, to alleviate the emotional and financial burden that caregivers may be facing at home.”
The study, “Describing settings of care in the last 100 days of life for cancer decedents: a population-based descriptive study” was published in Cancer Medicine.
Author block: Hafid A, Howard M, Webber C, Gayowsky A, Scott M, Jones A, Hsu A, Tanuseputro P, Downar J, Conen K, Manuel D, Isenberg S.
ICES is an independent, non-profit research institute that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting health care needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy. In October 2018, the institute formerly known as the Institute for Clinical Evaluative Sciences formally adopted the initialism ICES as its official name. For the latest ICES news, follow us on Twitter: @ICESOntario
McMaster University, one of four Canadian universities listed among the Top 100 universities in the world, is renowned for its innovation in both learning and discovery. It has a student population of 34,000, and more than 195,000 alumni in 162 countries. The Michael G. DeGroote School of Medicine has a global reputation for educational advancement and is internationally known for its research intensity and development of evidence-based medicine. Mcmaster.ca
The Bruyère Research Institute supports investigators who contribute to a better, more responsive health care system that delivers the best care to patients, residents, and families. The Institute provides solutions to improve the health and health care of aging and vulnerable Canadians. To learn more, visit http://www.bruyere.org.
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