title: Multicenter cohort study on the survival time of cancer patients dying at home or in a hospital: Does place matter?
abstract: Although the place of death has a great influence on the quality of death and dying for cancer patients, whether the survival time differs according to the place of death is unclear. The primary aim of this study was to explore potential differences in the survival time of cancer patients dying at home or in a hospital.
  
  
  
  This multicenter, prospective cohort study was conducted in Japan from September 2012 through April 2014 and involved 58 specialist palliative care services.
  
  
  
  Among the 2426 patients recruited, 2069 patients were analyzed for this study: 1582 receiving hospital-based palliative care and 487 receiving home-based palliative care. A total of 1607 patients actually died in a hospital, and 462 patients died at home. The survival of patients who died at home was significantly longer than the survival of patients who died in a hospital in the days' prognosis group (estimated median survival time, 13 days [95% confidence interval (CI), 10.3-15.7 days] vs 9 days [95% CI, 8.0-10.0 days]; P = .006) and in the weeks' prognosis group (36 days [95% CI, 29.9-42.1 days] vs 29 days [95% CI, 26.5-31.5 days]; P = .007) as defined by Prognosis in Palliative Care Study predictor model A. No significant difference was identified in the months' prognosis group. Cox proportional hazards analysis revealed that the place of death had a significant influence on the survival time in both unadjusted (hazard ratio [HR], 0.86; 95% CI, 0.78-0.96; P < .01) and adjusted models (HR, 0.87; 95% CI, 0.77-0.97; P = .01).
  
  
  
  In comparison with cancer patients who died in a hospital, cancer patients who died at home had similar or longer survival. Cancer 2016;122:1453-1460. © 2016 American Cancer Society.
authors.affiliation: Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Hamano
authors.affiliation: Department of Palliative Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Yamaguchi
authors.affiliation: Department of Palliative Medicine, Graduate School of Medicine, Osaka University, Suita, Japan.
authors.forename: Isseki
authors.initials: I
authors.lastname: Maeda
authors.affiliation: Department of Palliative Medicine, Shizuoka Saiseikai General Hospital, Suruga, Japan.
authors.forename: Akihiko
authors.initials: A
authors.lastname: Suga
authors.affiliation: Tsukuba Medical Center Foundation, Tsukuba, Japan.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Hisanaga
authors.affiliation: Palliative Care Department, Okayama Saiseikai General Hospital, Okayama City, Japan.
authors.forename: Tatsuhiko
authors.initials: T
authors.lastname: Ishihara
authors.affiliation: Matsue City Hospital, Matsue City, Japan.
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Iwashita
authors.affiliation: Department of Palliative Care Unit, Japan Community Health Care Organization (JCHO) Tokyo Shinjuku Medical Center, Tokyo, Japan.
authors.forename: Keisuke
authors.initials: K
authors.lastname: Kaneishi
authors.affiliation: Aozora Clinic, Matsudo City, Japan.
authors.forename: Shohei
authors.initials: S
authors.lastname: Kawagoe
authors.affiliation: Department of Palliative Medicine, Wakayama Medical University Hospital Oncology Center, Wakayama, Japan.
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Kuriyama
authors.affiliation: Department of Palliative Care, Tokyo Metropolitan Cancer and Infectious Disease Center, Komagome Hospital, Tokyo, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Maeda
authors.affiliation: Gratia Hospital Hospice, Mino, Japan.
authors.forename: Ichiro
authors.initials: I
authors.lastname: Mori
authors.affiliation: Department of Palliative Medicine, Graduate School of Medicine, Tohoku University, Sendai, Japan.
authors.forename: Nobuhisa
authors.initials: N
authors.lastname: Nakajima
authors.affiliation: Kawasaki Comprehensive Care Center, Kawasaki Municipal Ida Hospital, Kawasaki, Japan.
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Nishi
authors.affiliation: Palliative Care Team, Cancer Institute Hospital, Tokyo, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Sakurai
authors.affiliation: Department of Palliative Care, Aichi Cancer Center Hospital, Nagoya, Japan.
authors.forename: Satofumi
authors.initials: S
authors.lastname: Shimoyama
authors.affiliation: Shinjo Clinic, Kobe Shinjo Clinic, Kobe, Japan.
authors.forename: Takuya
authors.initials: T
authors.lastname: Shinjo
authors.affiliation: Iryouhoujinn Takumikai Osaka Kita Homecare Clinic, Osaka City, Japan.
authors.forename: Hiroto
authors.initials: H
authors.lastname: Shirayama
authors.affiliation: Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, Tokyo, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Yamada
authors.affiliation: Palliative and Supportive Care Division, Seirei Mikatahara General Hospital, Hamamatsu-Shi, Japan.
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Morita
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003643:Death; D005260:Female; D006699:Home Care Services / Q000706:statistics & numerical data; D017052:Hospital Mortality; D006801:Humans; D007564:Japan; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009369:Neoplasms; D010166:Palliative Care / Q000706:statistics & numerical data; D057240:Patient Preference; D011446:Prospective Studies; D017678:Sex Distribution; D016019:Survival Analysis; D013997:Time Factors
keywords: Prognosis in Palliative Care Study (PiPS) predictor model; advanced cancer patients; place of death; survival time; type of palliative care