title: A retrospective analysis of factors associated with selection of end-of-life care and actual place of death for patients with cancer.
abstract: OBJECTIVE
  The factors associated with end-of-life (EOL) care that patients with cancer selected and actual place of death (POD) is less elucidated. We analysed how specific EOL care, especially anticancer therapies, selected by patients with pancreatic carcinoma affected their POD in Japan.
  
  
  METHODS
  A retrospective cohort study using clinical records of a single institute.
  
  
  METHODS
  This study included 433 advanced or recurrent patients with pancreatic carcinoma who had completed standard chemotherapies and were receiving hospice care in the National Cancer Center Hospital between April 2008 and April 2011.
  
  
  METHODS
  We analysed statistical association factors, demographic information, geographical differences, medical environment, EOL care selection, along with actual POD using logistic regression analysis.
  
  
  RESULTS
  Of the 433 patients, 147 selected palliative care units (PCUs) as the POD; 229, hospital; and 57, home with hospice care. POD selection was associated with several factors. Notably, EOL care selection, especially the use of complementary and alternative medicine (CAM), is associated with POD selection (death in PCU; OR=0.23, p=0.02).
  
  
  CONCLUSIONS
  This study is, to the best of our knowledge, the first to unveil that EOL care selection is associated with POD in Japan. Certain factors such as gender, medical environment and EOL care selection might influence the POD. Patients who pursue aggressive anticancer therapies, such as CAM use, were possibly deprived of a chance of early reference to a PCU.
authors.affiliation: Department of Experimental Therapeutics, Exploratory Oncology Research & Clinical Trial Center, National Cancer Center, Tokyo, Japan.
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Kondo
authors.forename: Taichi
authors.initials: T
authors.lastname: Shimazu
authors.forename: Chigusa
authors.initials: C
authors.lastname: Morizane
authors.forename: Hiroko
authors.initials: H
authors.lastname: Hosoi
authors.forename: Takuji
authors.initials: T
authors.lastname: Okusaka
authors.forename: Hideki
authors.initials: H
authors.lastname: Ueno
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003643:Death; D005260:Female; D006699:Home Care Services; D017051:Hospice Care; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D010190:Pancreatic Neoplasms / Q000188:drug therapy; D057240:Patient Preference; D012189:Retrospective Studies; D013727:Terminal Care