Sociodemographic and clinical factors for non-hospital deaths among cancer patients: A nationwide population-based cohort study

BACKGROUND: Factors associated with place of death inform policies with respect to allocating end-of-life care resources and tailoring supportive measures. OBJECTIVE: To determine factors associated with non-hospital deaths among cancer patients. DESIGN: Retrospective cohort study of cancer decedents, examining factors associated with non-hospital deaths using multinomial logistic regression with hospital deaths as the reference category. SETTING/SUBJECTS: Cancer patients (n = 15254) in Singapore who died during the study period from January 1, 2012 till December 31, 2105 at home, acute hospital, long-term care (LTC) or hospice were included. RESULTS: Increasing age (categories ≥65 years: RRR 1.25–2.61), female (RRR 1.40; 95% CI 1.28–1.52), Malays (RRR 1.67; 95% CI 1.47–1.89), Brain malignancy (RRR 1.92; 95% CI 1.15–3.23), metastatic disease (RRR 1.33–2.01) and home palliative care (RRR 2.11; 95% CI 1.95–2.29) were associated with higher risk of home deaths. Patients with low socioeconomic status were more likely to have hospice or LTC deaths: those living in smaller housing types had higher risk of dying in hospice (1–4 rooms apartment: RRR 1.13–3.17) or LTC (1–5 rooms apartment: RRR 1.36–4.11); and those with Medifund usage had higher risk of dying in LTC (RRR 1.74; 95% CI 1.36–2.21). Patients with haematological malignancies had increased risk of dying in hospital (categories of haematological subtypes: RRR 0.06–0.87). CONCLUSIONS: We found key sociodemographic and clinical factors associated with non-hospital deaths in cancer patients. More can be done to enable patients to die in the community and with dignity rather than in a hospital.