Days spent at home in the last 6 months of life: a quality indicator of end of life care in patients with hematologic malignancies

Abstract

Despite advances in the management of hematologic malignancies, a significant proportion of patients die of their disease. We used administrative databases in Ontario, Canada (between 2005 and 2013) to determine the number of days spent at home in the last 6 months of life. We studied the predictors of the median number of days at home (DAH) using quantile regression. For the 11,127 patients with hematologic malignancies who died, the median number of DAH in the last 6 months was 156 days. Patients with acute leukemias (p < .0001), women (p < .0001), and those requiring transfusions (p < .0001) spent the fewest DAH. Patients assessed by palliative care prior to their last 6 months were likely to spend more time at home (p < .0001). Providing additional supports for patients nearing the end of life, including earlier access to palliative care and continued transfusion support, may increase the likelihood that patients can die at home.

Keywords:

• Hematologic malignancies
• days at home
• palliative care
• end of life
• health services research

Acknowledgements

The authors thank Service Ontario for providing Vital Statistics data.

Disclosure statement

No potential conflict of interest was reported by the authors.

Authorship

M.C.C., C.C.E., and S.S. designed and performed the research, analyzed the data, and wrote the paper. R.C. performed the research, analyzed the data, and wrote the paper. The authors have no conflict of interest to declare.

Additional information

Funding

This study was conducted with the support of Cancer Care Ontario (CCO) through funding provided by the Ontario Ministry of Health and Long-Term Care (MOHLTC). The study was supported by ICES, which is funded by an annual grant from the Ontario MOHLTC. The opinions, results, views, and conclusions reported in this paper are those of the authors and are independent from the funding sources. No endorsement by ICES or the Ontario MOHLTC is intended or should be inferred. Parts of this material are based on data and information compiled and provided by the Canadian Institute for Health Information (CIHI). However, the analyses, conclusions, opinions, and statements expressed herein are those of the author, and not necessarily those of CIHI. Parts of this material are based on data and information provided by Cancer Care Ontario (CCO). The opinions, results, view, and conclusions reported in this paper are those of the authors and do not necessarily reflect those of CCO. No endorsement by CCO is intended or should be inferred. Dr. Cheung receives funding from the Roy and Marjorie Linden Fund and the Joan Fisher and James Rowland Fund.