Patients with advanced cancer who die at home have greater quality of life (QOL) than patients who die in a hospital or intensive care unit. In addition, their caregivers experience less bereavement-related psychiatric illnesses, according to a study published online at the Journal of Clinical Oncology.
Using a prospective, longitudinal, multisite psychiatric epidemiologic design, researchers at the Dana-Farber Cancer Institute evaluated 718 patients with advanced cancer. Each caregiver assessed the patient’s QOL at the end of life within 2 weeks of the patient’s death. The caregiver’s mental health status was assessed at baseline and 6 months after the patient’s death.
For the patients, those who died in a hospital of intensive care unit experienced more physical and emotional distress and worse QOL than those who died at home with hospice (all P ≤.03). For the caregivers, having a loved one die in the intensive care unit was associated with higher risk for posttraumatic stress disorder (P = .02), and having a loved one die in the hospital was associated with a higher risk for prolonged grief disorder (P = .02), compared with having the death occur at home.
The researchers concluded that interventions that reduce terminal hospitalizations may improve the QOL of patients with advanced cancer at the end of life, as well as lower the risk for bereavement-related psychiatric illness in their caregivers.