Nursing

Intensive care medicine

Emergency medicine

Health care

Intensive care unit

Malignancy

Cause of death

Economics

Palliative care

Internal medicine

Confidence interval

Medicine

Economic growth

Disease

Cancer

Place of death

Journal of Palliative Medicine

A majority of patients with poor-prognosis cancer express a preference for in-home death; however, in-hospital deaths are common.We sought to identify characteristics associated with in-hospital death.Case series.Commercially insured patients with cancer who died between July 2010 and December 2013 and who had at least two outpatient visits at a tertiary cancer center during the last six months of life.Patient characteristics, healthcare utilization, and in-hospital death (primary outcome) were ascertained from institutional records and healthcare claims. Bivariate and multivariable analyses were used to evaluate the association of in-hospital death with patient characteristics and end-of-life outcome measures.We identified 904 decedents, with a median age of 59 years at death. In-hospital death was observed in 254 patients (28%), including 110 (12%) who died in an intensive care unit. Hematologic malignancy was associated with a 2.57 times increased risk of in-hospital death (95% confidence interval [CI] 1.91-3.45, p < 0.001), and nonenrollment in hospice was associated with a 14.5 times increased risk of in-hospital death (95% CI 9.81-21.4, p < 0.001). Time from cancer diagnosis to death was also associated with in-hospital death (p = 0.003), with the greatest risk among patients dying within six months of cancer diagnosis. All significant associations persisted in multivariable analyses that were adjusted for baseline characteristics.In-hospital deaths are common among commercially insured cancer patients. Patients with hematologic malignancy and patients who die without receiving hospice services have a substantially higher incidence of in-hospital death.

Characteristics Associated with In-Hospital Death among Commercially Insured Decedents with Cancer