Home hospitalization for palliative cancer care: factors associated with unplanned hospital admissions and death in hospital

Vincent Gamblin, Chloé Prod'homme, Adrien Lecoeuvre, André -Michel Bimbai, Joël Luu, Pierre-Alexandre Hazard, Arlette Da Silva, Stéphanie Villet, Marie-Cécile Le Deley, Nicolas Penel, Vincent Gamblin, Chloé Prod'homme, Adrien Lecoeuvre, André -Michel Bimbai, Joël Luu, Pierre-Alexandre Hazard, Arlette Da Silva, Stéphanie Villet, Marie-Cécile Le Deley, Nicolas Penel

Abstract

Background: Home hospitalization at the end of life can sometimes be perturbed by unplanned hospital admissions (UHAs, defined as any admission that is not part of a preplanned care procedure), which increase the likelihood of death in hospital. The objectives were to describe the occurrence and causes of UHAs in cancer patients receiving end-of-life care at home, and to identify factors associated with UHAs and death in hospital.

Methods: A retrospective, single-center study (performed at a regional cancer center in the city of Lille, northern France) of advanced cancer patients discharged to home hospitalization between January 2014 and December 2017. We estimated the incidence of UHA over time using Kaplan-Meier method and Kalbfleish and Prentice method. We investigated factors associated with the risk UHA in cause-specific Cox models. We evaluated factors associated with death in hospital in logistic regressions.

Results: One hundred and forty-two patients were included in the study. Eighty-two patients (57.7 %) experienced one or more UHAs, a high proportion of which occurred within 1 month after discharge to home. Most UHAs were related to physical symptoms and were initiated by the patient's family physician. A post-discharge palliative care consultation was associated with a significantly lower incidence of UHAs. Sixty-five patients (47.8 % of the deaths) died in hospital. In a multivariate analysis, living alone and the presence of one or more children at home were associated with death in hospital.

Conclusions: More than 40 % of cancer patients receiving end of life home hospitalization were not readmitted to hospital, reflecting the effectiveness of this type of palliative care setting. However, over half of the UHAs were due to an acute intercurrent event. Our results suggest that more efforts should be focused on anticipating these events at home - primarily via better upstream coordination between hospital physicians and family physicians.

Keywords: End‐of‐life care; Home hospitalization; Hospital readmission; Palliative care.

Conflict of interest statement

The authors declare that there is no competing interests.

Figures

Fig. 1
Fig. 1
Swimmer plot representing individual trajectories and successive UHAs from initial hospital discharge to death or last follow-up Each horizontal bar represents an individual trajectory from initial hospital discharge to death or last follow-up. The dots symbolize the repeated UHAs. We have sorted the observations by the overall survival duration. Only the first 12 months of follow-up are represented on this figure; further follow-up and UHAs occurring beyond 12 months are not represented for the 6 patients alive for more than 12 months (observations censored at 12 months)

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