Home care via Shutterstock
Besides the overwhelming despair inherent with the disease, terminally-ill cancer patients and their families often face a heart-wrenching choice when dealing with the imminence of death.
Should patients take final refuge in a hospital, where there is immediate access to expert medical care and assistance? Or alternatively, should they retreat to the familiar comforts of home, surrounded by friends and loved ones, for the final chapter of their lives?
Extending life as long as possible has always had widespread support, but that mindset might be finding a greater challenge following a recent Japanese study concluding that patients may really fare better -- and live longer -- at home, rather than in a hospital.
Dr. Jun Hamano from the University of Tsukuba, and his colleagues, studied over 2,000 cancer patients -- 1,582 of whom received hospital care and 487 others who were cared for at home. Researchers found that in the final weeks and days of life, those who died at home found a real benefit not available to those who died in hospitals.
"The survival of patients who died at home," the authors wrote, "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."
Previous studies have explored the mindsets of such patients in this regard. Some have shown that upwards of 8 in 10 terminal cancer patients prefer to spend their last days at home, rather than in a hospital. However, many still chose a hospital setting in order to extend life as long as possible, or because their physical distress could not be relieved at home.
Dr. Hamano's findings counter a common belief that choosing to go home equates to waving a white flag of surrender, and dying earlier.
"[O]ur finding, that home death does not actually have a negative influence on the survival of cancer patients at all, and rather may have a positive influence," said Dr. Hamano, "could suggest that the patient and family can choose the place of death in terms of their preference and values."
What benefits do patients get from home care, rather than from hospital care, that may explain this longer timeline? A 2014 study, published by the American Society of Clinical Oncology that surveyed the family caregivers of over 2,000 deceased cancer patients, provides some clues.
In addition to the benefits of more frequent interaction with family with fewer intrusions from hospital personnel, the caregivers pointed to the home setting as better for relationships with medical staff. And as one might expect, the patient being home allowed for an encouraging environment for pleasant thoughts, and to help keep hope alive.
(It's also believed that with medical costs frequently running at least 30 percent less at home than in a hospital, the patient can derive an intangible benefit from knowing that he/she is helping to minimize the family's financial burden.)
Finally, The Commonwealth Fund found in 2011 that home care can provide better patient safety, "especially for patients who are vulnerable to hospital-acquired infections and other complications of inpatient care.”
