Trends in the terminal care of cancer patients: South Australia, 1981-1990.
BACKGROUND
The increasing numbers of cancer patients, the high costs of terminal care, and the development of palliative care services have led to a growing interest in patterns of terminal cancer care. These patterns are relevant to the formulation and evaluation of health services policy.


OBJECTIVE
To investigate trends in the place of death of South Australian cancer patients between 1981 and 1990, and to examine associations of socio-demographic and clinical variables with the place of death.


METHODS
Data relating to 2715 deaths attributed to cancer in 1990 were extracted from the Central Cancer Registry. To assess trends, these data were directly standardised to the age-sex distribution of cancer deaths in 1981 and 1985 which were investigated in a previous study. Unconditional logistic regression was used to investigate predictors of place of death.


RESULTS
The proportion of deaths which occurred in major metropolitan public hospitals decreased from 40% in 1981 to 28% in 1990. Conversely, the proportion which occurred in hospice units increased from 5% to 20% over the same period. There was a decline in the proportion of deaths which occurred in private hospitals, but there was no significant change in the proportion which occurred in country hospitals or nursing homes. The proportion of deaths at home remained around 14%. Associated with place of death were age, sex, type of malignancy, survival time from diagnosis to death, Aboriginality, and area of residence. Further research to assess the clinical appropriateness of terminal care patterns is suggested.
Hunt
R
R
Southern Community Hospice Programme, Repatriation General Hospital, Adelaide, SA.
Bonett
A
A
Roder
D
D
D000368:Aged; D005260:Female; D006701:Home Nursing / Q000706:statistics & numerical data; D017051:Hospice Care / Q000706:statistics & numerical data / Q000639:trends*; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality* / Q000628:therapy; D009735:Nursing Homes / Q000706:statistics & numerical data; D010166:Palliative Care / Q000706:statistics & numerical data / Q000639:trends*; D013021:South Australia / Q000453:epidemiology; D013727:Terminal Care / Q000706:statistics & numerical data / Q000639:trends*