title: The influence of familial factors on the choice of the place of death for terminally ill breast cancer patients: a retrospective single-center study.
abstract: BACKGROUND
  The social or familial factors influencing the location chosen for end-of-life (EOL) care for terminally ill breast cancer patients are unknown.
  
  
  METHODS
  We retrospectively analyzed 195 patients with recurrent or progressive breast cancer who received anticancer treatment at the National Cancer Center Hospital between January 2008 and May 2012. Detailed data concerning the patients' demographic, familial, and clinical characteristics were collected, and multivariate and Cox logistic regression analyses were performed to evaluate the impact of these characteristics on the place of EOL care and on survival, respectively.
  
  
  RESULTS
  Sixty-eight patients (34.9 %) died in a hospital, 26 patients (13.3 %) at home, and 101 patients (51.8 %) in hospice. Most of the patients having caregivers received EOL care at palliative care facilities (hospice or home) [odds ratio (OR) 2.57; 95 % confidence interval (CI) 1-6.6; p = 0.05]. In contrast, patients with factors suggesting a clinically severe status (performance status ≥2, use of opioids, delirium, and ascites) more often received EOL care in a hospital. Among patients who received EOL care at hospice or home, patients with minor children received EOL care at home (OR 0.08; 95 % CI 0.02-0.38; p = 0.001). Patients with brain metastases chose hospice (OR 12.37; 95 % CI 2.25-68.13; p = 0.004). Furthermore, having a caregiver was associated with prolonged survival (hazard ratio 0.62; 95 % CI 0.39-0.97; p = 0.035).
  
  
  CONCLUSIONS
  Familial factors such as having children and caregivers significantly influenced the place of EOL care for terminally ill breast cancer patients.
authors.affiliation: Department of Breast and Medical Oncology, National Cancer Center Hospital, Tokyo, Japan. haranokenichi@gmail.com.|Department of Medical Oncology, Nippon Medical School Musashikosugi Hospital, 1-396, Kosugi-cho, Nakahara-ku, Kawasaki, Kanagawa, 211-0063, Japan. haranokenichi@gmail.com.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Harano
authors.affiliation: Department of Breast and Medical Oncology, National Cancer Center Hospital, Tokyo, Japan.
authors.forename: Kan
authors.initials: K
authors.lastname: Yonemori
authors.affiliation: Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, Nagoya, Japan.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Hirakawa
authors.affiliation: Department of Breast and Medical Oncology, National Cancer Center Hospital, Tokyo, Japan.
authors.forename: Chikako
authors.initials: C
authors.lastname: Shimizu
authors.affiliation: Department of Medical Oncology, Nippon Medical School Musashikosugi Hospital, 1-396, Kosugi-cho, Nakahara-ku, Kawasaki, Kanagawa, 211-0063, Japan.
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Katsumata
authors.affiliation: Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.
authors.forename: Akihiko
authors.initials: A
authors.lastname: Gemma
authors.affiliation: Department of Breast and Medical Oncology, National Cancer Center Hospital, Tokyo, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Fujiwara
authors.affiliation: Department of Breast and Medical Oncology, National Cancer Center Hospital, Tokyo, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Tamura
mesh_terms: D001943:Breast Neoplasms / Q000401:mortality / Q000523:psychology; D017028:Caregivers; D005190:Family; D005260:Female; D017051:Hospice Care; D006761:Hospitals; D006801:Humans; D007564:Japan; D015999:Multivariate Analysis; D010166:Palliative Care; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D013727:Terminal Care / Q000706:statistics & numerical data; D019452:Terminally Ill / Q000523:psychology
keywords: Breast cancer; Caregiver; End-of life care; Palliative care