Clinical, sociodemographic, and local system factors associated with a hospital death among cancer patients

Abstract

The study was conducted to examine factors associated with hospital deaths among a group of cancer patients. A retrospective chart review of the M. D. Anderson Cancer Center Tumor Registry was conducted. Participants were all adult cancer patients, residents of the State of Texas diagnosed and treated since January 1, 1990, and who died during the years 1999 and 2000. The study outcome was the site of death. The inclusion criteria were met by 866 patients of whom 504 (58%) died in a hospital. The group included 489 (56%) men. A number of 641 (74%) were White, 104 (12%) Hispanic, 92 (11%) Black, and 29 (3%) of other origin. The majority, 501 (58%), had been diagnosed with stage IV disease, and the median survival time was 14 months. Multivariate logistic regression analysis showed patients diagnosed with hematologic cancers to be significantly more likely (p<0.001) of dying in hospitals, odds ratio [OR 2.88] and confidence interval [95% CI 1.79-4.63], women diagnosed with breast and gynecological cancers were significantly less likely (p=0.03) of dying at hospitals odds ratio [OR 0.64] and confidence interval [95% CI 0.42-0.96], when compared with patients diagnosed with other cancers. Lower household income per zip code of residency was marginally associated (p=0.06) with hospital deaths. The study identified groups of cancer patients at risk of hospital death. These results should account when planning the allocation of hospital palliative care services as well as when informing policy decisions about health care financing and delivery of these services.