Disparities in location of death of adolescents and young adults with cancer: A longitudinal, population study in California

Title

Disparities in location of death of adolescents and young adults with cancer: A longitudinal, population study in California

Creator

Rajeshuni N; Johnston EE; Saynina O; Sanders LM; Chamberlain LJ

Identifier

Publisher

Cancer

Date

2017

Subject

Neoplasms; Death; Male; Hospital Mortality; Young Adult; Humans; Adult; Adolescent; Female; Retrospective Studies; Attitude to Death; Hospital Mortality/td [Trends]; California; Hospices/sn [Statistics & Numerical Data]; Patient Preference/sn [Statistics & Numerical Data]; Nursing Homes/sn [Statistics & Numerical Data]; Residence Characteristics/sn [Statistics & Numerical Data]

Description

BACKGROUND: Patients with a terminal illness should have access to their chosen location of death. Cancer is the leading cause of non-accidental death among adolescents and young adults (AYAs; those aged 15-39 years). Although surveys have suggested that a majority of these patients prefer a home death, to the authors' knowledge, little is known regarding their barriers to accessing their preferred location of death. As a first step, the authors sought to determine, across a large population, 20-year trends in the location of death among AYA patients with cancer. METHODS: Using the Vital Statistics Death Certificate Database of the California Office of Statewide Health Planning and Development, the authors performed a retrospective, population-based analysis of California patients with cancer aged 15 to 39 years who died between 1989 and 2011. Sociodemographic and clinical factors associated with hospital death were examined using multivariable logistic regression. RESULTS: Of 30,573 AYA oncology decedents, 57% died in a hospital, 33% died at home, and 10% died in other locations (eg, hospice facility or nursing facility). Between 1989 and 1994, hospital death rates decreased from 68.3% to 53.6% and at-home death rates increased from 16.8% to 35.5%. Between 1995 and 2011, these rates were stable. Those individuals who were more likely to die in a hospital were those aged <30 years, of minority race, of Hispanic ethnicity, who lived <=10 miles from a specialty center, and who had a diagnosis of leukemia or lymphoma. CONCLUSIONS: Overall, the majority of AYA cancer deaths occurred in a hospital, with a 5-year shift to more in-home deaths that abated after 1995. In-hospital deaths were more common among younger patients, patients of minority race/ethnicities, and those with a leukemia or lymphoma diagnosis. Further study is needed to determine whether these rates and disparities are consistent with patient preferences. Cancer 2017;123:4178-4184. � 2017 American Cancer Society.

Citation List Month

Oncology 2018 List

Collection

Citation

Rajeshuni N; Johnston EE; Saynina O; Sanders LM; Chamberlain LJ, “Disparities in location of death of adolescents and young adults with cancer: A longitudinal, population study in California,” Pediatric Palliative Care Library, accessed August 1, 2021, https://pedpalascnetlibrary.omeka.net/items/show/16079.

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