The place where cancer patients die may affect their quality of life and end of life as well as the psychiatric health of their caregivers, according to a study published in the Journal of Clinical Oncology.

End-of-life care for cancer patients may be provided in a variety of settings, including  the hospital, intensive care unit (ICU), or at home with hospice care. The place where a cancer patient dies may not only affect the patient but the caregiver as well.

To better understand how place of death impacts patients and caregivers, researchers followed 342 patient-caregiver pairs. All patients had advanced cancer and were followed from enrollment in the study to their death (an average of 4.5 months). Caregivers reported on the quality of life and end of life of their patients within two weeks of their death. The caregivers’ mental health was assessed at enrollment and again six months after their patient had died.

It appeared that patients who died in the hospital or ICU had a worse quality of life and a worse end of life and experienced more physical and emotional distress than patients who died at home with hospice care. Caregivers whose patients died in the hospital or ICU had a greater risk of posttraumatic stress disorder and extended grief disorder than those whose patients died at home; this remained true after accounting for any preexisting mental illness among caregivers.

The researchers conclude that place of death does affect patients and caregivers, with home deaths associated with better quality of life for patients and better mental health for caregivers. They suggest increased efforts to avoid hospitalization at the end of life and increase use of home hospice care.

Reference: Wright AA, Keating NL, Balboni TA, et al. Place of death: correlations with quality of life of patients with cancer and predictors of bereaved caregivers’ mental health. Journal of Clinical Oncology [early online publication]. September, 13, 2010.

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