Palliative care is provided for patients with serious illnesses like cancer. It focuses on quality of life and may include treatment to manage symptoms. It can be provided in a facility or at home. A recent study looked at whether the location of this care can impact how long a patient lives.
Researchers at the University of Tsukuba in Japan investigated the survival time of advanced cancer patients receiving at-home palliative care versus those in a palliative care ward within a hospital facility. The goal was to learn if in-home patients may be at a disadvantage.
The paper, published in the journal PLOS One, reads, “One primary concern about receiving care at home is that survival might be shortened because the quality and quantity of treatment provided at home will be inferior to that given in the hospital.”
To see if this was the case, the researchers compared survival times of 2,878 patients who had taken part in two studies on the topic. They had either utilized one of 45 home-based palliative care services between July and December 2017 or one of 23 hospital-based palliative care services between January and December 2017. The team then focused on whether a patient’s prognosis was days, weeks, or months to live.
The researchers found that for those who had a prognosis of days, the home-based patients had a median survival time of 10 days, compared with nine for those at a hospital. For those expected to live for weeks, the home-based group had a median survival time of 32 days versus 22 at a hospital. Among the months group, meanwhile, the figures were 65 days and 32 days, respectively.
The authors say this work has provided information in an area with little research.
They write, “To the best of our knowledge, this is the first large-scale prospective, multicenter study to compare the survival time of advanced cancer patients receiving home-based palliative care or hospital-based palliative care adjusting for symptoms and treatment factors.”
As such, they say more research is needed. However, they say a possible reason behind the findings is that people with a longer prognosis had more of a disruption to their autonomy and motivation if they were in a hospital. The similar timeline for those with only days of life expected is possibly due to the dying process taking precedent over any type of specialized care.
The team also noted some limitations, including that the study didn’t look into symptoms before death and how treatment and care changed, so they can’t positively say that people do live longer at home. However, they say the study should reassure those worried that spending the end of one’s life at home will shorten survival.