Abstract
Background: While many patients in the terminal phase of cancer hope for home palliative care and home death, most patients cannot be cared for or cannot die at home. In particular, home palliative care for patients with head and neck cancer is considered to be potentially difficult. We conducted a retrospective study to examine the reasons for generally not caring for patients with head and neck cancer at the end of life at home.
Methods: We performed a retrospective study on primary disease, follow-up duration, cause of death, place of death and treatment at the end of life in 64 patients who died of head and neck cancer (without death due to complications resulting from treatment) between 2003 and 2012, who had undergone first-line treatment in the Department of Otolaryngology – Head and Neck Surgery, Yamagata University School of Medicine.
Results: With regard to the place of death, 25 patients (39.1%) died at an affiliated hospital and 24 patients (37.5%) at our hospital. These hospitals are all regional center hospitals and acute hospitals, and therefore bear a great burden of end-of-life care. Patients who died at home numbered only 2 (3.1%). By cause of death, average follow-up duration in patients who died of distant metastasis was 25.5 months, which was significantly longer than in patients who died of regional lymph node metastasis (14.6 months) or due to cancer at the primary site (14.0 months). In addition, the rate of patients who died of distant metastasis who needed treatments such as of a wound or airway, and nutritional supply at the end of life, was significantly lower than in the other two groups. Although the two cases of home death also needed treatments at the end of life, they might have been able to die at home because they were wealthy, had family able to care for them at home, and a medical affiliation.
Conclusion: To permit palliative home care and home death for patients in the terminal phase of head and neck cancer, we have to improve our skills in the management of palliative care, such as treatment of wounds and airway, nutritional supply at the end of life and building networks of medical affiliations.
