Comparison of survival times of advanced cancer patients with palliative care at home and in hospital

Jun Hamano; Ayano Takeuchi; Masanori Mori; Yasuhiro Saitou; Takahide Yamaguchi; Nobuyuki Miyata; Masakatsu Shimizu; Ryo Yamamoto; Yousuke Kimura; Yoshiyuki Kamiyama; Yasuyuki Arai; Hiroshi Matsuo; Hideki Shishido; Kazushi Nakano; Tomohiro Nishi; Hiroka Nagaoka; Naosuke Yokomichi; Isseki Maeda; Takashi Yamaguchi; Tatsuya Morita; Takuya Shinjo

doi:10.1371/journal.pone.0284147

Comparison of survival times of advanced cancer patients with palliative care at home and in hospital

PLoS One. 2023 Apr 13;18(4):e0284147. doi: 10.1371/journal.pone.0284147. eCollection 2023.

Authors

Jun Hamano¹, Ayano Takeuchi², Masanori Mori³, Yasuhiro Saitou⁴, Takahide Yamaguchi⁵, Nobuyuki Miyata⁶, Masakatsu Shimizu⁷, Ryo Yamamoto⁸, Yousuke Kimura⁹, Yoshiyuki Kamiyama¹⁰, Yasuyuki Arai¹¹, Hiroshi Matsuo¹², Hideki Shishido¹³, Kazushi Nakano¹⁴, Tomohiro Nishi¹⁵, Hiroka Nagaoka¹, Naosuke Yokomichi³, Isseki Maeda^{3

16}, Takashi Yamaguchi¹⁷, Tatsuya Morita¹⁸, Takuya Shinjo¹⁹

Affiliations

¹ Faculty of Medicine, Department of Palliative and Supportive Care, University of Tsukuba, Tsukuba, Japan.
² Department of Preventive Medicine and Public Health, School of Medicine, Keio University, Tokyo, Japan.
³ Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan.
⁴ GP Clinic Jiyugaoka, Tokyo, Japan.
⁵ Ohisama Medical Corporation, Ohisama Clinic, Hyogo, Japan.
⁶ Miyata Clinic, Chikusei, Ibaraki, Japan.
⁷ Shimizu Medical Clinic, Akashi, Hyogo, Japan.
⁸ Saku Central Hospital Advanced Care Center, Saku-shi, Nagano, Japan.
⁹ Yamato Clinic, Sakuragawa, Ibaraki, Japan.
¹⁰ Okinawa Chubu Hospital, Uruma, Okinawa, Japan.
¹¹ Iki-iki Clinic, Yuki, Ibaraki, Japan.
¹² Marguerite Clinic, Nagoya, Aichi, Japan.
¹³ Shishido Internal Medicine Clinic, Sakura, Chiba, Japan.
¹⁴ Nakano Zaitakuiryou Clinic, Ishiki, Kagosima, Japan.
¹⁵ Kawasaki Municipal Ida Hospital, Kawasaki, Kanagawa, Japan.
¹⁶ Department of Palliative Care, Senri-chuo Hospital, Osaka, Japan.
¹⁷ Department of Medicine, Division of Palliative Care, Konan Medical Center, Kobe, Japan.
¹⁸ Division of Palliative and Supportive Care, Palliative Care Team, and Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan.
¹⁹ Shinjo-clinic, Kobe, Hyogo, Japan.

Abstract

Objectives: One primary concern about receiving care at home is that survival might be shortened because the quality and quantity of treatment provided at home will be inferior to that given in the hospital. Although our previous study demonstrated a longer survival of those with home-based palliative care (PC), it lacked adjustment for some potential confounders including symptoms and treatments during the stay. We aimed to compare the survival times among advanced cancer patients receiving home-based and hospital-based PC with adjusting for symptoms and treatments.

Method: We compared survival time of participants who enrolled two multicenter, prospective cohort studies of advanced cancer patients at 45-home-based PC services between July 2017 and December 2017, and at 23-hospital-based PC services between January 2017 and December 2017. We analyzed with stratification by the estimated survival of Days, Weeks, and Months, which were defined by modified Prognosis in Palliative care Study predictor models-A. We conducted a Cox regression analysis with adjusting for potential confounders including symptoms and treatments during the stay.

Results: A total of 2,998 patients were enrolled in both studies and 2,878 patients were analyzed; 988 patients receiving home-based PC and 1,890 receiving hospital-based PC. The survival time of patients receiving home-based PC was significantly longer than that of patients receiving hospital-based PC for the Days Prognosis (estimated median survival time: 10 days [95% CI 8.1-11.8] vs. 9 days [95% CI 8.3-10.4], p = 0.157), the Weeks prognosis (32 days [95% CI 28.9-35.4] vs. 22 days [95% CI 20.3-22.9], p < 0.001), and the Months Prognosis, (65 days [95% CI 58.2-73.2] vs. 32 days [95% CI 28.9-35.4], p < 0.001).

Conclusion: In this cohort of advanced cancer patients with a Weeks or Months prognosis, those receiving home-based PC survived longer than those receiving hospital-based PC after adjusting for symptoms and treatments.

Copyright: © 2023 Hamano et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Hospitals
Humans
Neoplasms* / therapy
Palliative Care*
Prognosis
Prospective Studies
Retrospective Studies

Grants and funding

Funding Source This EASED study was supported in part by a Grant-in-Aid from the Japanese Hospice Palliative Care Foundation. This COME Home study was supported in part by JSPS KAKENHI Grant Number 19K10551 and 22H03305. The sponsor played no role in the study design, collection, analysis, or interpretation of the data, writing of the report, or in the decision to submit the paper for publication.