Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #112131

Marylou Cardenas-Turanzas, MD, DrPH¹, Richard Grimes, PhD², Eduardo Bruera, MD³, Beth Quill, MPH⁴, and Guillermo Tortolero-Luna, MD, PhD². (1) Section of Health Services Research Department of Biostatistics and Applied Mathematics, M.D. Anderson Cancer Center, 1515 Holcombe Blvd Box 196, Houston, TX 77030, (713) 563 4303, mcardena@mail.mdanderson.org, (2) UT School of Public Health, 1200 Herman Pressler Drive, Houston, TX 77030, (3) Department of Palliative Care and Rehabilitation Medicine, M.D. Anderson Cancer Center, 1515 Holcombe Blv Box 008, Houston, TX 77030, (4) School of Public Health, University of Texas-Houston, Center for Excellence in Public Health Practice, 1200 Herman Pressler Suite W236, Houston, TX 77030

OBJECTIVE: Quality of care for the dying is a public health concern. This study examines the clinical, sociodemographic and local health care systems factors associated with dying in a hospital by a group of cancer patients. METHODS: The study was based on a retrospective chart review of the M.D. Anderson Cancer Center Tumor Registry. Adult cancer patients, residents of the state of Texas diagnosed and treated since January 1, 1990, and who died during the years 1999 and 2000 were included in the study. RESULTS: The inclusion criteria were met by 887 patients, of whom 515 (58.1%) died in a hospital. This group included 499 (56.3%) men. Six hundred and fifty-nine (74.3%) were white, 107 (12%) Hispanic, 92 (10.4%) Black, and 29(3.3%) were of other origin. The average age at death was 62 ± 13.9 years (median 63). The majority, 501 (56.5%), had been diagnosed with distant metastasic (stage IV) disease, and the median survival time was 14 months. In bivariate analysis, clinical factors significantly associated with the place of death were: cancer site (p= 0.001), severity of illness (p = 0.05), and survival time (p = 0.01). Median household income per zip code of residency was the only sociodemographic factor significantly associated with the place of death (p = 0.01), while the type of county of residence (urban/rural) was marginally associated (p = 0.06) with the study outcome. Multivariate logistic regression analysis showed patients diagnosed with a hematologic cancer to be significantly more likely (p <0.001) of dying in a hospital odds ratio [OR 3.31] confidence interval [95% CI 2.08-5.25] than patients diagnosed with other cancers. Median household income per zip code of residency was also a significant determinant of place of death (p = 0.03), as patients in lower family income categories were more likely to die in hospitals than patients in higher family income categories. CONCLUSIONS: The study showed potential users of end-of-life services in hospitals are patients diagnosed with leukemia and from low- income households. This should be accounted for when planning allocation of these types of health services.

Learning Objectives:

• Assess the risk factors for hospital death for cancer patients

Keywords: End-of-Life Care, Cancer

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.