Clinical and demographic factors associated to the place of death in advanced cancer patients assisted at home in Italy

Introduction: Studies on the end of life have shown that patients with advanced cancer prefer to die at home, and their caregivers agree with this choice. However, many cancer patients still die in hospital. Few data are available for Southern Europe and, in particular, for Italy. This study examined the factors associated with the place of death in a cohort of Italian patients with advanced cancer who were assisted by a palliative home care team. Methods: We conducted a retrospective observational study to identify the association between place of death and clinical and demographic factors in a sample of 1374 patients. To analyze the factors associated with the place of death, we used univariate analyses by nonparametric tests and multinomial regression tests. Results: Five variables related to the place of death were significant in univariate analysis, but only three were retained significant in the multinomial regression test. The older patients died more frequently at home rather than in hospital (P < 0.05); a greater number of home visits by a physician in the last 30 days of home care was correlated with dying at home (P < 0.001), a greater number of hospitalizations during the last 30 days of home care was correlated with dying in hospital and in hospice (P < 0.001). Conclusions: The study shows that at the end of life the frequency of home visits by the palliative care physicians and a continuous at-home palliative service could favor dying at home in a cohort of cancer patients.