[Determinants associated with location of terminal care in the cancer patient]

Data relating to the place where terminal care was provided and where death was experienced were extracted from the charts of 100 terminally ill cancer patients who had been admitted to the first free-standing hospice in Japan. Of these 100 patients who died between October 1993 and May 1995, 91 patients died in the hospice, five in the hospital, and only four at home. To clarify factors associated with the place where terminal care was provided to the cancer patient, the length of stay at home during the last 30 days of life was examined. We divided the 100 cases into two groups, group 1 comprising 60 cases who had spent less than seven days at home, group 2 comprising 40 patients who had spent seven days or more at home, and compared these two groups in terms of age, sex, diagnosis, strength of pain, morphine dosage, use of intravenous fluids, performance status, place of care before admission to hospice, awareness of having cancer, distance from the hospice, the number of family members in the household, and housing environment. Using multiple logistic regression, three factors are identified as significantly impedimental to staying at home: high morphine dosage (> 60 mg daily oral morphine equivalence), direct transfer from hospital to hospice, and living on the second or upper floors in an apartment building. The data suggest that the development of palliative home care and improvement of housing environment may enable cancer patients to spend more time at home during their terminal phase.