Hospital as a site of death of cancer patients in Italy: A registry-based analysis and time trends

Background: Place of death is relevant both for individuals and for the society. Home is universally considered the optimal place of death while dying in hospital may be a signal of inappropriate end-of-life care. We aimed at studying the place of death of patients with cancer in Italy in a five-year period.

Patients and methods: The death-certificate database published by the Italian National Institute of Statistics (ISTAT) was analysed, searching the place of death and the main disease related to death. Data from 2015 to 2019 were used, to exclude the influence of the COVID pandemic. Cancer, "cognitive impairment and Alzheimer's disease" (CIAD) and "cardiovascular and cerebrovascular diseases" (CCD) were the examined diseases. The place of death was categorized as "acute care hospital", "hospice" or "other long-term care (LTC) structures" and "home". We implemented an ordinary linear regression model to verify whether there was a statistically significant variation across the selected time (i), and whether a substitution effect among sites of death could be hypothesized (ii).

Results: Data on 769,517 deaths were retrieved. In 2019 35.39 % patients with cancer died in hospital, 39.57 % died at home and 20.06 % died in hospice or in other LTC structures. In the examined period, death at home decreased by 3.09 % (95 % C.I. -3.18 - -2.99; p<0.01); death in hospice and long-term structures increased by 2.71 % (95 % C.I. 2.66 - 2.76; p<0.01); death in hospital increased by 0.3 % (95 % C.I. 0.23 - 0.36; p<0.01). For patients with CIAD, death in hospital increased by 0.98 % (95 % C.I. 0.80 - 1.17; p<001) and for patients with CCD decreased by 1.43 % (95 % I.C. -1.47 - -1.39; p<0.01). Death at home decreased in both diseases.

Conclusions: More than one-third of cancer patients die in acute care hospitals and this percentage is slightly increasing in the analysed period. Mortality at home decreased in all the examined diseases. Dying at home is being progressively less frequent, while hospitals continue to represent a frequent place of death.