title: Age, gender, will, and use of home-visit nursing care are critical factors in home care for malignant diseases; a retrospective study involving 346 patients in Japan.
abstract: BACKGROUND
  We aimed to clarify the factors affecting outcomes of home care for patients with malignant diseases.
  
  
  METHODS
  Of 607 patients who were treated in 10 clinics specialized in home care between January and December 2007 at Chiba, Fukuoka, Iwate, Kagoshima, Tochigi and Tokyo prefectures across Japan, 346 (57%; 145 men and 201 women) had malignant diseases. We collected information on medical and social backgrounds, details of home care, and its outcomes based on their medical records.
  
  
  RESULTS
  Median age of the patients was 77 years (range, 11-102), and 335 patients were economically self-sufficient. Their general condition was poor; advanced cancer (n = 308), performance status of 3-4 (n = 261), and dementia (n = 121). At the beginning of home care, 143 patients and 174 family members expressed their wish to die at home. All the patients received supportive treatments including fluid replacement and oxygenation. Median duration of home care was 47 days (range, 0-2,712). 224 patients died at home. For the remaining 122, home care was terminated due to complications (n = 109), change of attending physicians (n = 8), and others (n = 5). The factors which inhibited the continuity of home care were the non-use of home-visit nursing care (hazard ratio [HR] = 1.78, 95% confidence interval [CI]: 1.05-3.00, p = 0.03), the fact that the patients themselves do not wish to die at home (HR = 1.83, CI: 1.09-3.07, p = 0.02), women (HR = 1.81, CI: 1.11-2.94, p = 0.02), and age (HR = 0.98, CI: 0.97-1.00, p = 0.02).
  
  
  CONCLUSIONS
  Continuation of home care is influenced by patients' age, gender, will, and use of home-visit nursing.
authors: Division of Social Communication System for Advanced Clinical Research, the Institute of Medical Science, the University of Tokyo, Tokyo, Japan. alice-smn@umin.net.
authors: Yuko
authors: Y
authors: Kodama
authors: Tomoko
authors: T
authors: Matsumura
authors: Takuhiro
authors: T
authors: Yamaguchi
authors: Morihito
authors: M
authors: Takita
authors: Shohei
authors: S
authors: Kawagoe
authors: Yukihiro
authors: Y
authors: Kimura
authors: Satoshi
authors: S
authors: Hirahara
authors: Hiroshi
authors: H
authors: Suzuki
authors: Hideki
authors: H
authors: Ohta
authors: Shigeru
authors: S
authors: Onozawa
authors: Tadashi
authors: T
authors: Wada
authors: Yukiyasu
authors: Y
authors: Nakamura
authors: Kazushi
authors: K
authors: Nakano
authors: Masahiro
authors: M
authors: Kami
authors: Koichiro
authors: K
authors: Yuji