title: Going back to home to die: does it make a difference to patient survival?
abstract: BACKGROUND
  Many patients wish to stay at home during the terminal stage of cancer. However, there is concern that medical care provided at home may negatively affect survival. This study therefore explored whether the survival duration differed between cancer patients who received inpatient care and those who received home care.
  
  
  METHODS
  We retrospectively investigated the place of care/death and survival duration of 190 cancer patients after their referral to a palliative care consultation team in a Japanese general hospital between 2007 and 2012. The patients were classified into a hospital care group consisting of those who received palliative care in the hospital until death, and a home care group including patients who received palliative care at home from doctors in collaboration with the palliative care consultation team. Details of the place of care, survival duration, and patient characteristics (primary site, gender, age, history of chemotherapy, and performance status) were obtained from electronic medical records, and analyzed after propensity score matching in the place of care.
  
  
  RESULTS
  Median survival adjusted for propensity score was significantly longer in the home care group (67.0 days, n = 69) than in the hospital care group (33.0 days, n = 69; P = 0.0013). Cox's proportional hazard analysis revealed that the place of care was a significant factor for survival following adjustment for covariates including performance status.
  
  
  CONCLUSIONS
  This study suggests that the general concern that home care shortens the survival duration of patients is not based on evidence. A cohort study including more known prognostic factors is necessary to confirm the results.
authors.affiliation: Home Palliative Care Committee, Takaoka Medical Service Region, 387-1 Futatsuka, Takaoka, Toyama 933-0816 Japan.
authors.forename: Nozomu
authors.initials: N
authors.lastname: Murakami
authors.affiliation: Department of Medical Oncology, Toyama University Hospital, 2630 Sugitani, Toyama, Toyama 930-0194 Japan.
authors.forename: Kouichi
authors.initials: K
authors.lastname: Tanabe
authors.affiliation: Department of Palliative and Supportive Care, Seirei Mikatahara Hospital, 3453 Mikataharacho, Kita-ku, Hamamatsu, Shizuoka 433-8105 Japan.
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Morita
authors.affiliation: Board of Palliative Care, Saiseikai Takaoka Hospital, Toyama Prefecture, 387-1 Futatsuka, Takaoka, Toyama 933-0816 Japan.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Kadoya
authors.affiliation: Board of Palliative Care, Saiseikai Takaoka Hospital, Toyama Prefecture, 387-1 Futatsuka, Takaoka, Toyama 933-0816 Japan.
authors.forename: Masanari
authors.initials: M
authors.lastname: Shimada
authors.affiliation: Board of Palliative Care, Saiseikai Takaoka Hospital, Toyama Prefecture, 387-1 Futatsuka, Takaoka, Toyama 933-0816 Japan.
authors.forename: Kaname
authors.initials: K
authors.lastname: Ishiguro
authors.affiliation: Board of Palliative Care, Saiseikai Takaoka Hospital, Toyama Prefecture, 387-1 Futatsuka, Takaoka, Toyama 933-0816 Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Endo
authors.affiliation: Board of Palliative Care, Saiseikai Takaoka Hospital, Toyama Prefecture, 387-1 Futatsuka, Takaoka, Toyama 933-0816 Japan.
authors.forename: Koichiro
authors.initials: K
authors.lastname: Sawada
authors.affiliation: Board of Palliative Care, Saiseikai Takaoka Hospital, Toyama Prefecture, 387-1 Futatsuka, Takaoka, Toyama 933-0816 Japan.
authors.forename: Yasunaga
authors.initials: Y
authors.lastname: Fujikawa
authors.affiliation: Board of Palliative Care, Saiseikai Takaoka Hospital, Toyama Prefecture, 387-1 Futatsuka, Takaoka, Toyama 933-0816 Japan.
authors.forename: Rumi
authors.initials: R
authors.lastname: Takashima
authors.affiliation: Board of Palliative Care, Saiseikai Takaoka Hospital, Toyama Prefecture, 387-1 Futatsuka, Takaoka, Toyama 933-0816 Japan.
authors.forename: Yoko
authors.initials: Y
authors.lastname: Amemiya
authors.affiliation: Board of Palliative Care, Saiseikai Takaoka Hospital, Toyama Prefecture, 387-1 Futatsuka, Takaoka, Toyama 933-0816 Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Iida
authors.affiliation: Home Palliative Care Committee, Takaoka Medical Service Region, 387-1 Futatsuka, Takaoka, Toyama 933-0816 Japan.
authors.forename: Shiro
authors.initials: S
authors.lastname: Koseki
authors.affiliation: Department of Medical Oncology, Toyama University Hospital, 2630 Sugitani, Toyama, Toyama 930-0194 Japan.
authors.forename: Hatsuna
authors.initials: H
authors.lastname: Yasuda
authors.affiliation: Department of Medical Oncology, Toyama University Hospital, 2630 Sugitani, Toyama, Toyama 930-0194 Japan.
authors.forename: Tatsuhiko
authors.initials: T
authors.lastname: Kashii
keywords: Home palliative care; Palliative care team; Place of care; Propensity score; Survival time
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