Patient characteristics, home-visit nursing influence success of home cancer care
MedWire News: Age, gender, patient will, and use of home-visit nursing care are important factors in the continuation of home care among cancer patients, show results of a Japanese study.
"Home care has provided a new treatment option for cancer patients," write Yuko Kodama (University of Tokyo) and co-authors, who add: "It remains unknown who are optimal candidates for this treatment." They say that home care offers a number of benefits to terminally ill patients, but that it is important to investigate the factors that determine whether patients decide to continue with care at home.
They conducted a study of 346 cancer patients (145 men and 201 women) registered at 10 Japanese clinics specializing in home care.
The median age of the patients was 77 years, with a range from 11 to 102 years. General patient health was poor, remark the researchers; 308 patients had advanced cancer, and all patients received supportive treatments such as fluid replacement and oxygenation.
At the beginning of home care, 41% of patients and 50% of family members expressed the wish the patient die at home. During the course of home care four patients and seven families changed their minds, either due to increasing burden on the family, fear of a sudden change in the patient's condition, or due to living alone.
The average duration of home care was 47 days and 224 patients died at home. The remaining 122 stopped receiving home care due to hospital admission because of complications (n=109), change in physician (n=8), admission to a nursing home (n=3), return to outpatient treatment after improvement (n=1), and disappearance (n=1).
Women were 81% more likely to discontinue home care treatment than men. The researchers speculate that the reason for this is cultural, as studies from the UK, USA, Australia, and Canada, showed no such gender disparity, they say. Traditional views in terms of gender roles may mean Japanese women miss the opportunity to receive medical home care, explain Kodama and colleagues.
They also found older age was associated with longer duration of home care, as was the use of home-visit nurses and the patient's personal will to continue receiving their care at home.
The researchers recognize that their study is limited by its small size and retrospective design. "A large, international cohort study to investigate the continuation of cancer home care should be considered," they write.
Their research is published in the journal BMC Palliative Care.
By Chloe McIvor