JBM  Vol.7 No.2 , February 2019
A Study on Locations of Death and Factors Associated with Death among Cancer Patients in South Korea
Abstract: Background: Location of death has been used to examine an indicator for good death. This study aims to examine location of death among patients with three major cancers (gastric, liver, and lung) and other factors associated with location of death in South Korea. Methods: We selected the medical and pharmacy claims data for health services and location of death among the 42,596 decedents with cancer (lung 16,632, liver 15,872, gastric 10,092) from 2009 to 2013. We used logistic regressions to identify factors associated with home death. Outcome measures are locations of death (hospital, outpatient clinics or emergency room and home). Results: Only 8.9% died at home whereas 46.5% died in hospital as inpatients. Patients with more than one comorbid cancer or receivers for any supportive care were significantly more likely to die in hospital. Female and younger than 55 years old liver cancer patients were associated with home death. Patients living in metropolitan area, or paying more insurance premium, or being public aid beneficiaries, were associated with home death. Conclusions: The supportive care service use prior to death was significantly associated with increasing odds to hospital death. Being older than 75, or having multiple cancers was significant factors associated with hospital death, whereas living in metropolitan area, lower income or emergency visit were significant factors with home death. These findings are opposite to what is found, as the palliative care and hospice is predominantly hospital-centered. The findings emphasize a need to available end-of-life care in community for dying patients.
Cite this paper: Rhee, Y. , Tae, Y. , Lee, Y. , Jang, S. , Cohen, J. , Choi, Y. (2019) A Study on Locations of Death and Factors Associated with Death among Cancer Patients in South Korea. Journal of Biosciences and Medicines, 7, 26-41. doi: 10.4236/jbm.2019.72003.

[1]   Ahlner-Elmqvist, M., et al. (2004) Place of Death: Hospital-Based Advanced Home Care versus Conventional Care: A Prospective Study in Palliative Cancer Care. Palliative Medicine, 18, 585-593.

[2]   Albrecht, J., Gruber-Baldini, A.L., Fromme, E.K., McGregor, J.C., Lee, D.S. and Furuno, J.P. (2013) Quality of Hospice Care for Individuals with Dementia. Journal of the American Geriatrics Society, 61, 1060-1065.

[3]   Hoare, S., et al. (2015) Do Patients Want to Die at Home? A Systematic Review of the UK Literature, Focused on Missing Preferences for Place of Death. PLoS ONE, 10, 1-17.

[4]   Keam, B., et al. (2013) The Attitudes of Korean Cancer Patients, Family Caregivers, Oncologists and Members of the General Public toward Advance Directives. Supportive Care in Cancer, 21, 1437-1444.

[5]   Thomas, C., Morris, S.M. and Clark, D. (2004) Place of Death: Preferences among Cancer Patients and Their Carers. Social Science & Medicine, 58, 2431-2444.

[6]   Evans, W.G., et al. (2006) Is There no Place like Home? Caregivers Recall Reasons for and Experience upon Transfer from Home Hospice to Inpatient Facilities. Journal of Palliative Medicine, 9, 100-110.

[7]   Gomes, B., et al. (2013) Heterogeneity and Changes in Prefer-ences for Dying at Home: A Systematic Review. BMC Palliative Care, 12, 12-17.

[8]   Guerriere, D., et al. (2015) Predictors of Place of Death for Those in Receipt of Home-Based Palliative Care Services in Ontario, Canada. Journal of Palliative Care, 31, 76-88.

[9]   Schou-Andersen, M., Ullersted, M.P., Jensen, A.B. and Neergaard, M.A. (2016) Factors Associated with Preference for Dying at Home among Terminally Ill Patients with Cancer. Scandinavian Journal of Caring Sciences, 30, 466-476.

[10]   Houttekier, D., et al. (2010) Involvement of Palliative Care Services Strongly Predicts Place of Death in Belgium. Journal of Palliative Medicine, 13, 1461-1468.

[11]   Cohen, J., Houttekier, D., Onwuteaka-Philipsen, B., Miccinesi, G., et al. (2010) Which Patients with Cancer Die at Home? A Study of Six European Countries Using Death Certificate Data. Journal of Clinical Oncology, 28, 2267-2273.

[12]   Cohen, J., Houttekier, D., Chambaere, K., Bilsen, J. and Deliens, L. (2011) The Use of Palliative Care Services Associated with Better Dying Circumstances. Results from an Epidemiological Population-Based Study in the Brussels Metropolitan Region. Journal of Pain and Symptom Management, 42, 839-851.

[13]   Wallace, S.K., Waller, D.K., Tilley, B.C., Piller, L.B., Price, K.J., et al. (2015) Place of Death among Hospitalized Patients with Cancer at the End of Life. Journal of Palliative Medicine, 18, 667-676.

[14]   Dy, S.M., Wolff, J.L. and Frick, K.D. (2007) Patient Characteristics and End-of-Life Health Care Utilization among Medicare Beneficiaries in 1989 and 1999. Medical Care, 45, 926-930.

[15]   Mohsen, H., Haddad, P., Allam, A. and Hassan, A. (2014) Patterns in Place of Cancer Death in the State of Qatar: A Population-Based Study. PLoS ONE, 9, e109615.

[16]   Newman, A., Thompson, J. and Chandler, E.M. (2013) Continuous Care: A Home Hospice Benefit. Clinical Journal of Oncology Nursing, 17, 19.

[17]   Beernaert, K., Deliens, L., Pardon, K., Van den Block, L., et al. (2015) What Are Physicians’ Reasons for Not Referring People with Life-Limiting Illnesses to Specialist Palliative Care Services? A Nationwide Survey. PLoS ONE, 10, e0137251.

[18]   Cohen, J., Pivodic, L., Miccinesi, G., Onwuteaka-Philipsen, B.D., et al. (2015) International Study of the Place of Death of People with Cancer: A Population-Level Comparison of 14 Countries across 4 Continents Using Death Certificate Data. British Journal of Cancer, 113, 1397-1404.

[19]   National Cancer Center (2015) Cancer Facts and Figures 2014 in the Republic of Korea. Seoul.

[20]   Sekiguchi, K., Bell, C.L., Masaki, K.H. and Fischberg, D.J. (2014) Factors Associated with In-Hospital Death by Site of Consultation among Elderly Inpatients Receiving Pain and Palliative Care Consultations. Journal of Palliative Medicine, 17, 1353-1358.

[21]   Teno, J., Lynn, J., Connors, A.F., Wenger, N., Phillips, R.S., Alzola, C., Murphy, D.P., Desbiens, N. and Knaus, W.A. (1997) The Illusion of End-of-Life Resource Savings with Advance Directives. Support Investigators. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment. Journal of the American Geriatrics Society, 45, 513-518.

[22]   Tangeman, J.C., Rudra, C.B., Kerr, C.W. and Grant, P.C. (2014) A Hospice-Hospital Partnership-Reducing Hospitalization Costs and 30-Day Readmissions among Seriously Ill Adults. Journal of Palliative Medicine, 17, 1005-1010.

[23]   Morrison, H. (2005) Health Care System Factors Affecting End-of-Life Care. Journal of Palliative Medicine, 8, S79-S87.

[24]   Hebert, R.S., Dang, Q. and Schulz, R. (2007) Religious Beliefs and Practices Are Associated with Better Mental Health in Family Caregivers of Patients with Dementia: Findings from the REACH Study. The American Journal of Geriatric Psychiatry, 15, 292-300.

[25]   Tilden, V.P., Tolle, S.W., Drach, L.L. and Perrin, N.A. (2004) Out-of-Hospital Death: Advance Care Planning, Decedent Symptoms, and Caregiver Burden. Journal of the American Geriatrics Society, 52, 532-539.

[26]   Teno, J.M., Weitzen, S., Fennell, M.L. and Mor, V. (2001) Dying Trajectory in the Last Year of Life: Does Cancer Trajectory Fit Other Diseases? Journal of Palliative Medicine, 4, 457-464.

[27]   Teno, J.M., Bynum, J.P., Leland, N.E., Miller, S.C., Morden, N.E., Scupp, T., Goodman, D.C. and Mor, V. (2013) Change in End-of-Life Care for Medicare Beneficiaries: Site of Death, Place of Care, and Health Care Transitions in 2000, 2005, and 2009. JAMA, 309, 470-477.

[28]   Kim, J.H., Kim, S.M., Joo, J.S. and Lee, K.S. (2012) Factors Associated with Medical Cost among Patients with Terminal Cancer in Hospice Units. Journal of Palliative Care, 28, 5-12.

[29]   Sasao, S., Tanabe, K., Morita, T., Takahashi, T., et al. (2015) Facility-Related Factors Influencing the Place of Death and Home Care Rates for End-Stage Cancer Patients. Journal of Palliative Medicine, 18, 691-696.

[30]   Fukui, S., Fujita, J., Tsujimura, M., Sumikawa, Y. and Hayashi, Y. (2011) Predictors of Home Death of Home Palliative Cancer Care Patients: A Cross-Sectional Nationwide Survey. International Journal of Nursing Studies. International Journal of Nursing Studies, 48, 1393-1400.

[31]   Nakamura, S., Kuzuya, M., Funaki, Y., Matsui, W. and Ishiguro, N. (2010) Factors Influencing Death at Home in Terminally Ill Cancer Patients. Geriatrics & Gerontology International, 10, 154-160.

[32]   Lee, L.C., Hu, C.C., Loh, el-W. and Hwang, S.F. (2014) Factors Affecting the Place of Death among Hospice Home Care Cancer Patients in Taiwan. American Journal of Hospice and Palliative Medicine, 31, 300-306.

[33]   Alonso-Babarro, A., Bruera, E., Varela-Cerdeira, M., Boya-Cristia, M.J., Madero, R., Torres-Vigil, I., De Castro, J. and González-Barón, M. (2011) Can This Patient Be Discharged Home? Factors Associated with At-Home Death among Patients with Cancer. Journal of Clinical Oncology, 29, 1159-1167.

[34]   Yun, Y.H., Lim, M.K., Choi, K.S. and Rhee, Y.S. (2006) Predictors Associated with the Place of Death in a Country with Increasing Hospital Deaths. Palliative Medicine, 20, 455-461.

[35]   Lee, Y.S. (2013) The Past, Present and Future Strategies of Korean Social Work in Hospice and Palliative Care. Korean Journal of Hospice and Palliative Care, 16, 65-73.

[36]   Park, C.S., Yoon, S.J. and Jung, Y. (2013) The Status of Home-Based Hospice Care in Korea. Korean Journal of Hospice and Palliative Care, 16, 98-107.

[37]   Rhee, Y. (2015) Hospice and Palliative Care Services in South Korea Supported by the National Health Insurance (NHI) Program. Health, 7, 689-695.

[38]   Health Insurance and Research Assessment (HIRA) (2016) The Guidelines for Pilot Project: Pricing and Services items in Home-Based Hospice and Palliative Care Services. Health Insurance and Research Assessment, Seoul.