Dying at home better for cancer patients

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Cancer patients who die at home do so more peacefully - and their caregivers end up doing better emotionally, too, researchers reported on Monday.

At-home hospice care not only saves money but saves physical and emotional pain as well, they reported in the Journal of Clinical Oncology.

“Patients with cancer who died in an intensive care unit or hospital experienced more physical and emotional distress and worse quality of life at the end of life,” Dr. Alexi Wright of the Dana-Farber Cancer Institute in Boston and colleagues wrote.

"If patients are aware that more-aggressive care may affect not only their quality of life, but also their loved ones after their death, they may make different choices,” Wright said in a statement.

Wright’s team studied 342 terminal cancer patients and their loved ones until the patients died, usually about 4 1/2 months later.

“Although most patients with cancer prefer to die at home, 36 percent die in a hospital and 8 percent die in an intensive care unit (ICU),” they wrote.

When patients died in an ICU, their loved ones were five times more likely to be diagnosed with post-traumatic stress disorder, or PTSD, Wright’s team found.

Twenty-one percent of caregivers of patients who died in an ICU developed PTSD, compared with 4.4 percent of those caring for patients who died with home hospice.

“This is the first study to show that caregivers of patients who die in ICUs are at a heightened risk for developing PTSD,” they wrote.

Families and loved ones of patients who died in the hospital were also more likely to have prolonged grief disorder, an intense, disabling form of grief that lasts more than six months.

Home-based hospice care is meant to relieve suffering, but at least one study last month showed it may also help cancer patients live a little longer.

It also costs far less than treating cancer patients in a hospital. “Nearly 25 percent of Medicare expenditures are spent on intensive care in the final month of life, despite limited evidence of improved patient outcomes,” Wright’s team noted.

SOURCE:  Journal of Clinical Oncology, online September 13, 2010.

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