title: Patterns in place of cancer death in the State of Qatar: a population-based study.
abstract: BACKGROUND
  International studies show that most people prefer to die at home; however, hospitals remain the most common place of death (PoD). This study aims to investigate the patterns in PoD and the associated factors, which are crucial for end-of-life cancer care enhancement.
  
  
  METHODS
  This retrospective, population-based study analyzed all registered cancer deaths in Qatar between January 1, 2006 and December 31, 2012 (n = 1,224). The main outcome measures were patient characteristics: age, gender, nationality, cancer diagnosis, year of death, and PoD. Time trends for age-standardized proportions of death in individual PoDs were evaluated using chi-square analysis. Odds ratio (OR) were determined for variables associated with the most preferred (acute palliative care unit [APCU] and hematology/oncology ward) versus least preferred (ICU and general medicine ward) PoDs in Qatar, stratified by nationality.
  
  
  RESULTS
  The hematology/oncology ward was the most common PoD (32.4%; 95% CI 26.7-35.3%) followed by ICU (31.4%; 95% CI 28.7-34.3%), APCU (26.9%; 95% CI 24.3-29.6%), and general medicine ward (9.2%; 95% CI 7.6-11.1%). APCU trended upward (+0.057/year; p<0.001), while the hematology/oncology ward trended downward (-0.055/year; p<0.001). No statistically significant changes occurred in the other PoDs; home deaths remained low (0.4%; 95% Cl 0.38-0.42). Qataris who died from liver cancer (OR 0.23) and aged 65 or older (OR 0.64) were less likely to die in the APCU or hematology/oncology ward (p<0.05). Non-Qataris who died from pancreatic cancer (OR 3.12) and female (OR 2.05) were more likely to die in the APCU or hematology/oncology ward (p<0.05). Both Qataris and non-Qataris who died from hematologic malignancy (OR 0.18 and 0.41, respectively) were more likely to die in the ICU or general medicine ward (p<0.05).
  
  
  CONCLUSIONS
  A high percentage of cancer deaths in Qatar occur in hospital. As home was the preferred PoD for most people, effective home care and hospice programs are needed to improve end-of-life cancer care.
authors.affiliation: Weill Cornell Medical College in Qatar, Doha, Qatar.
authors.forename: Hassan
authors.initials: H
authors.lastname: Mohsen
authors.affiliation: Weill Cornell Medical College in Qatar, Doha, Qatar.
authors.forename: Pascale
authors.initials: P
authors.lastname: Haddad
authors.affiliation: National Center for Cancer Care and Research, Doha, Qatar.
authors.forename: Ayman
authors.initials: A
authors.lastname: Allam
authors.affiliation: Weill Cornell Medical College in Qatar, Doha, Qatar; National Center for Cancer Care and Research, Doha, Qatar; Cancer Management & Research, Medical Research Institute, Alexandria University, Egypt.
authors.forename: Azza
authors.initials: A
authors.lastname: Hassan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016001:Confidence Intervals; D003643:Death; D003710:Demography; D005260:Female; D019538:Health Care Surveys; D006699:Home Care Services / Q000706:statistics & numerical data*; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D038622:Internationality; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology* / Q000401:mortality; D016017:Odds Ratio; D017150:Public Sector / Q000706:statistics & numerical data; D011780:Qatar / Q000453:epidemiology; D014480:United Nations; D055815:Young Adult