Abstract
BackgroundWe aimed to clarify the factors affecting outcomes of home care for patients with malignant diseases.MethodsOf 607 patients who were treated in 10 clinics specialized in home care between January and December 2007 at Chiba, Fukuoka, Iwate, Kagoshima, Tochigi and Tokyo prefectures across Japan, 346 (57%; 145 men and 201 women) had malignant diseases. We collected information on medical and social backgrounds, details of home care, and its outcomes based on their medical records.ResultsMedian age of the patients was 77 years (range, 11-102), and 335 patients were economically self-sufficient. Their general condition was poor; advanced cancer (n = 308), performance status of 3-4 (n = 261), and dementia (n = 121). At the beginning of home care, 143 patients and 174 family members expressed their wish to die at home. All the patients received supportive treatments including fluid replacement and oxygenation. Median duration of home care was 47 days (range, 0-2,712). 224 patients died at home. For the remaining 122, home care was terminated due to complications (n = 109), change of attending physicians (n = 8), and others (n = 5). The factors which inhibited the continuity of home care were the non-use of home-visit nursing care (hazard ratio [HR] = 1.78, 95% confidence interval [CI]: 1.05-3.00, p = 0.03), the fact that the patients themselves do not wish to die at home (HR = 1.83, CI: 1.09-3.07, p = 0.02), women (HR = 1.81, CI: 1.11-2.94, p = 0.02), and age (HR = 0.98, CI: 0.97-1.00, p = 0.02).ConclusionsContinuation of home care is influenced by patients' age, gender, will, and use of home-visit nursing.
Highlights
We aimed to clarify the factors affecting outcomes of home care for patients with malignant diseases
In response to the wishes of such patients, home care for terminally ill cancer patients has been developed since the 1990s, and studies on this issue are still increasing in number [2]
Most patients were in poor general conditions, and had several complications other than malignant diseases
Summary
We aimed to clarify the factors affecting outcomes of home care for patients with malignant diseases. Home care has provided a new treatment option for cancer patients, while it remains unknown who are optimal candidates for this treatment. Several researchers reported that success of home care is influenced by medical conditions, incomes, and education levels of patients and their families [3,4,5]. These studies provided us valuable information on home care; they are small-sized studies with their backgrounds varied widely. The factors influencing performance of home care have not yet been elucidated
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