Patterns and Predictors of Dying at Home for Adults With Primary Malignant Brain Tumours: A Comprehensive National
K Le Calvez1, J Droney2, R Mauricaite1
1Department of Radiotherapy, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom; Computational Oncology Laboratory, Institute of Global Health Innovation, Imperial College London, London, United Kingdom.
Purpose:
Malignant brain tumours have a poor prognosis. Most people would prefer to die in their own home, rather than in a hospital or other settings. We aim to examine predictors of the place of death for adult patients with malignant brain tumours in England.
Patients And Methods:
This is a retrospective cohort study. We examined factors associated with death at home using logistic regression. We included adult patients diagnosed with a malignant brain tumour between 2013 and 2018 from England's national cancer registry data (N = 20,598). Our dependent variable was place of death (home/not home) and our independent variables were sex, age, region, tumour type, deprivation index, line of treatment, treatment close to death, and interval between diagnosis and death.
Results:
The analysis revealed that receiving treatment during the last 3 months had the most substantial effect, with a significant decrease of 38% in the odds of dying at home, while having received one line of treatment increased the odds of dying at home by 21%. Following this, residing in the West Midlands or London was associated with a notable decrease of 20% and 7%, respectively, in the odds of dying at home compared to the South East. Other factors that influenced the likelihood of dying at home included being female, which increased the odds by 2%, whereas living in a deprived area (fourth quintile) decreased the odds by 13%. Furthermore, being diagnosed with glioblastoma (GBM) was associated with 7% higher odds of dying at home. Finally, for one unit of change (day) in the interval between diagnosis and death, the odds of dying at home increases by a factor of 1.09. For one unit of change (year) in the variable age, the odds of dying at home increases by a factor of 1.05.
Conclusions:
We have presented the first ever national study of place of death and predictors of this for patients with malignant brain tumours in England. Patients with malignant brain tumours are more likely to die at home than the general population; however, this effect is most marked in patients with GBM. Having treatment within the last 3 months of life, living longer post diagnosis, and geographical region also influenced the change of dying at home. This work provides an essential baseline comprehensive national report on place of death for a large national cohort with a poor prognosis.
