Choosing to die at home does not hasten death for patients with terminal cancer

A large study from Japan found that cancer patients who died at home tended to live longer than those who died in hospitals. Published early online in Cancer, a peer-reviewed journal of the American Cancer Society, the findings suggest that oncologists should not hesitate to refer patients for home-based palliative care simply because less medical treatment may be provided.

Most people say that they would prefer to be cared for at home if they were dying, but it's unclear if the care they receive there would be as good as the care delivered at a hospital. Jun Hamano, MD, of the University of Tsukuba in Japan, and his colleagues looked at the issue by prospectively studying 2069 patients, comprising 1582 patients receiving hospital-based palliative care and 487 receiving home-based palliative care.

The investigators found that the survival of patients who died at home was significantly longer than that of patients who died in hospitals, even after adjusting for patients' demographic and clinical characteristics, as well as other factors.

"The cancer patient and family tend to be concerned that the quality of medical treatment provided at home will be inferior to that given in a hospital and that survival might be shortened; however, our finding—that home death does not actually have a negative influence on the survival of cancer patients at all, and rather may have a positive influence—could suggest that the patient and family can choose the place of death in terms of their preference and values," said Dr. Hamano. "Patients, families, and clinicians should be reassured that good home hospice care does not shorten patient life, and even may achieve longer survival."