© 2005-2012 American Society of Clinical Oncology (ASCO). All rights reserved worldwide.
Posted online September 13, 2010, on www.jco.org.
A new study of patients dying of cancer and their caregivers has found that individuals who die in the hospital or intensive care unit have a worse quality of life at the end of their lives compared to those cancer patients who die at home with hospice services. In addition, their caregivers are more likely to develop psychiatric problems while grieving.
In the study, published in the Journal of Clinical Oncology, researchers interviewed 342 patients with advanced cancer and their caregivers. Patients were followed from the time of study enrollment to death, a median of 4.5 months. They assessed the patients' quality of life at the end of life within two weeks of the patient's death. At the same time, the researchers evaluated the caregivers' mental health at the beginning of their participation and at six months after the patient died.
The investigators found that patients who died in an ICU or hospital experienced more physical and emotional distress and worse quality of life than those who died at home with hospice. The study showed that caregivers of cancer patients who died in intensive care units had a five-fold greater risk of developing Post-Traumatic Stress Disorder (PTSD) compared with caregivers of patients who died at home with hospice services.
The investigators found that 21 percent of caregivers of patients who died in the ICU or hospital developed PTSD compared to 4.4 percent of caregivers of those who died at home with hospice. Similarly, 21.6 percent of caregivers of patients who died in the hospital or ICU were associated with prolonged grief disorder compared to home hospice deaths (5.2 percent).
The authors recommended several potential ways to reduce the number of cancer patients choosing to die in hospitals instead of at home or in hospice care, including increasing end-of-life discussions between patients, caregivers and physicians and improving patient education about end-of-life care.
What this means to patients
Patients with advanced cancer are receiving increasingly aggressive care at the end of life. Despite the fact that most patients prefer to die at home, more than a third die in the hospital, including eight percent in the intensive care unit. Patients and their caregivers need to be aware of their choices in end of life care, including the potential benefits of hospice care at home, and how their decisions may affect the patient's quality of life and the caregiver's mental health. They should discuss their options with the patient's physicians and healthcare providers.