Where Older Patients with Cancer Die? A Retrospective Study

Abstract

Home is the preferred place of death for most cancer patients. We examined which characteristics of older patients with cancer may have influenced this choice and how important may be relevant an early collaboration between oncologists and palliatives. Hospitalized patients aged ≥70 were screened by G8 questionnaire and evaluated by Comprehensive Geriatric Assessment (CGA) to identify frail and unfit ones and define the most appropriate end-of-life setting with palliatives. Using the G8 questionnaire, we screened 135 patients evaluated with the CGA and identified 75 frail, 55 unfit, and five fit. Sixty-six patients died in Hospice: 43 (50%) were male and 23 (47%) female, median age was 78. Forty-two (56%) patients were Frail and 23 (42%) Unfit. Patients with low/no dependence (median score ADL/IADL) were 14 (30%), and with high/moderate dependence were 51 (61%). Malnutrition was present in 43 patients (70%), and MMSE was none/low dementia in 28 (36%). Fifty-two patients died at home: 33 (38%) male and 19 (39%) female, median age was 78. Twenty-three (31%) patients were Frail and 27 (49%) Unfit. Patients with low/no dependence (median score ADL/IADL) were 28 (60%), and those with high/moderate dependence were 21 (25%). Malnutrition was present in 27 patients (33%), and MMSE was none/low dementia in 37 patients (48%). Active collaboration with palliatives and early identification of Unfit and Frail patients can allow 38% of patients to die at home. Patients who died at home have a better functional and cognitive status than patients who died in Hospice.