Cohen, J., Pivodic, L., Miccinesi, G., Onwuteaka-Philipsen, B.D., Naylor, W.A., Wilson, D.M., Loucka, M., Csikos, A., Pardon, K., Van den Block, L., Ruiz-Ramos, M., Cardenas-Turanzas, M., Rhee, Y., Aubry, R., Hunt, K., Teno, J., Houttekier, D. and Deliens, L. (2015) International study of the place of death of people with cancer: a population-level comparison of 14 countries across 4 continents using death certificate data. British Journal of Cancer, 113 (9), 1397-1404. (doi:10.1038/bjc.2015.312). (PMID:26325102)
Abstract
BACKGROUND:Where people die can influence a number of indicators of the quality of dying. We aimed to describe the place of death of people with cancer and its associations with clinical, socio-demographic and healthcare supply characteristics in 14 countries.
METHODS:Cross-sectional study using death certificate data for all deaths from cancer (ICD-10 codes C00-C97) in 2008 in Belgium, Canada, Czech Republic, England, France, Hungary, Italy, Mexico, the Netherlands, New Zealand, South Korea, Spain (2010), USA (2007) and Wales (N=1,355,910). Multivariable logistic regression analyses evaluated factors associated with home death within countries and differences across countries.
RESULTS:Between 12% (South Korea) and 57% (Mexico) of cancer deaths occurred at home; between 26% (Netherlands, New Zealand) and 87% (South Korea) occurred in hospital. The large between-country differences in home or hospital deaths were partly explained by differences in availability of hospital- and long-term care beds and general practitioners. Haematologic rather than solid cancer (odds ratios (ORs) 1.29-3.17) and being married rather than divorced (ORs 1.17-2.54) were most consistently associated with home death across countries.
CONCLUSIONS:A large country variation in the place of death can partly be explained by countries' healthcare resources. Country-specific choices regarding the organisation of end-of-life cancer care likely explain an additional part. These findings indicate the further challenge to evaluate how different specific policies can influence place of death patterns.
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