Marital status affects place of cancer death
By Sarah Guy, medwireNews Reporter
03 April 2013
PLoS Med 2013; 10: e1001410

medwireNews: Having a hematologic cancer or being single, widowed, or divorced, reduces cancer patients' chances for dying at home or in a hospice, study findings show.

Indeed, while home and hospice deaths have increased over recent years in the UK, hospital remained the most common place of death, at 48% overall during the 18-year data period.

The findings have prompted the UK researchers to suggest that healthcare facilities should be improved and enhanced to support increased home and hospice deaths, since this is where patients with cancer usually prefer to be.

Home and hospice followed hospital as the most common place of death, at 25% and 16%, respectively. The proportion of home deaths declined slightly but steadily, by 0.38% per year, from the start of the study period in 1993. However, from 2003/4, the trend in age- and gender-adjusted home deaths reversed, rising by 0.87% per year to reach 26.5% in 2010.

By contrast, hospital death rates fluctuated until 2005/6, when there was a significant 1.82% reduction, countering the rise in home deaths, write Wei Gao (King's College London) and colleagues in PloS Medicine.

Overall, individuals with hematologic cancers were the least likely of all those with cancer to die at home or in a hospice, but the proportion ratio increased from 0.46 in 1993-1995 to 0.52 in 2006-2010. Conversely, those with lung cancer showed little improvement in the chances for dying at home or in hospice, but their proportion ratio remained relatively high throughout the study period, at 0.87-0.88.

In an analysis of factors associated with where a patient died, marital status was the second most important factor after cancer location in 1993-1995 and 2006-2010, report Gao et al. Using married couples as a reference, the proportion ratio for death at home or in hospice was 0.76, 0.86, and 0.88 for single, widowed, and divorced patients during this later period, respectively. Almost half of the 2,281,223 study participants died as single, widowed, or divorced individuals.

"Married individuals may receive more home support from their partners, enabling them more likely to die in their preferred place," remark the researchers.

"Policy makers and health services planners should take into consideration the support from partners or spouses, other family members, and the local community in order to design effective end-of-life care services," they add.

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