Report on 15 Terminal Head and Neck Cancer Patients in Home Medical Care

Abstract

　In terms of end-of-life care, the number of head and neck cancer patients who receive home medical care is expected to increase in the future.

　However, there are few reports as yet. We retrospectively investigated the clinical courses and outcomes in 15 patients with terminal head and neck cancer who received home medical care from our clinic between April 2016 and December 2018. The average age of the patients was 73.7 y.o. and the male: female ratio was 12: 3; the primary cancer sites were as follows: oropharynx/hypopharynx/larynx/oral cavity/thyroid gland. In regard to the previous institutions attended, 13 cases (86.7%) had attended the department of otolaryngology of acute care hospitals and 2 patients (13.3%) had attended internal medicine clinics. Mean observation period: 73.4 days; mean number of visits: 10.6; mean number of emergency visits: 2.0. The reasons for the emergency visits to home by the clinic doctor were death diagnosis, delirium/disturbance of consciousness, nasogastric tube obstruction, bleeding, and tracheal cannula obstruction. In regard to death, 9 patients (60.0%) died at home, which was the lowest home death rate as compared to patients with other organ cancers at our clinic; 6 patients (40%) died in hospital, with a report of difficulty in continuing home care due to excessive family caregiving burden in 5 of the cases. Three patients were referred to their previous hospitals (reverse referral rate: 23.1%, average duration of home medical care: 34 days). There is a possibility that intervention by otolaryngologists could reduce the difficulties in home care for head and neck cancer patients and their families, contribute to the introduction and continuation of home care, and reduce hospital stays in acute care hospitals.