Mortality Pattern of Cancer Patients Followed in Palliative Care - Experience in a Portuguese Public Hospital

Abstract

Introduction: Although most of cancer patients prefer to die at home, studies show that they mostly die in hospital setting. Aim: To identify the places of death of patients with solid cancer under follow-up by a Palliative Care team of a Portuguese public hospital and to recognize factors that influence the place of death. Methods: Retrospective study of cancer patients followed up by a Palliative Care team of a Portuguese public hospital and whose deaths occurred between 1st January 2022 and 1st January 2024. Demographic and clinical data were reviewed through clinical file consultation and were analyzed by SPSS®v.29, considering p value <0.05 as statistically significant. Results: From 413 included cancer patients, 60.5% were male and 72.9% were ECOG 3 or 4. Median age was 75 years and median follow-up duration in Palliative Care was 40 days. Death in hospital setting occurred in 64.4% of the patients. The most common types of cancer were gastrointestinal and hepato-bilio-pancreatic (41.6%) and lung cancers (18.6%). Death due to cancer progression was the main cause of death (88.4%). In a multivariate logistic regression, factors associated with higher chances of dying in hospital setting were age < 75 years (OR 1.881) and follow-up duration in Palliative Care < 30 days (OR 2.586). Death due to cancer progression was associated with higher odds of dying outside the hospital setting (OR 0.029). Conclusion: Death in hospital setting is still predominant among cancer patients. Early referral to Palliative Care and providing end-of-life care in extra-hospital context can be ways to reverse this trend. Studies with higher samples are needed to analyze the impact of different types of cancer in the place of death.