Dying at Home Is More Peaceful for Cancer Patients

Cancer patients who die at home do so more peacefully, and their caregivers end up doing better emotionally as well, according to a new study.

Researchers at the Dana-Farber Cancer Institute (Boston, MA, USA), Harvard Medical School (Boston, MA, USA), and Brigham and Women's Hospital (Boston, MA, USA) conducted a prospective, longitudinal, multisite study of 342 patients with advanced cancer and their caregivers; the patients were followed from enrollment to death, a median of 4.5 months later. The patients' quality of life (QOL) was assessed at the end of life (EOL) by caregiver report within two weeks of death. The bereaved caregivers' mental health was assessed at baseline and 6 months after loss.

The results showed that patients with cancer who died in an intensive care unit (ICU) or hospital experienced more physical and emotional distress and worse QOL at the EOL, compared with patients who died at home hospice. ICU deaths were associated with a heightened risk for posttraumatic stress disorder (PTSD) (21.1%) in bereaved family members, compared with PTSD involving home hospice deaths (4.4%), after adjustment for caregivers' preexisting psychiatric illnesses. Similarly, hospital deaths were associated with a heightened risk for prolonged grief disorder (21.6%), compared with home hospice deaths (5.2%). Families and loved ones of patients who died in the hospital were also more likely to have prolonged grief disorder, an intense, disabling form of grief that lasts more than six months. The study was published early online on September 13, 2010, in the Journal of Clinical Oncology.

"Patients with cancer who died in an intensive care unit or hospital experienced more physical and emotional distress and worse quality of life at the end of life,” said lead author Alexi Wright, M.D., of the Dana-Farber Cancer Institute. "If patients are aware that more aggressive care may affect not only their quality of life, but also their loved ones after their death, they may make different choices.”

Home hospice care is a general philosophy of care that aims to maximize the quality of life as death approaches, and is usually recommended six months before death. Home hospice places the emphasis is on preventing pain and otherwise keeping the patient comfortable rather than making any efforts to cure the disease. If a patient has terminal cancer, chemotherapy treatments will be stopped because they would cause unnecessary illness and suffering, while pain medicines would be prescribed to make the patient comfortable; when a patient who is under hospice care dies, family members are asked to not call for an ambulance, as first-response teams are under an obligation to try to resuscitate someone rather than letting them die in peace.

Related Links:
Dana-Farber Cancer Institute
Harvard Medical School
Brigham and Women's Hospital