Characteristics of cancer patients dying at home during the COVID-19 pandemic: A study based on vital statistics from 2015 to 2022 in Japan

Background

The coronavirus disease 2019 (COVID-19) pandemic has markedly affected end-of-life care, notably increasing home deaths among cancer patients in Japan. This study investigated the characteristics of cancer patients who died at home during the pandemic and the associated factors before and during the pandemic.

Methods

Vital statistics from January 2015 to December 2022 were analyzed to evaluate trends in home deaths among cancer patients aged 0 to 113 years, pre-pandemic (January 2015 to March 2020) and during the pandemic (April 2020 to December 2022). Home deaths were assessed by demographics, including age, sex, marital status, and residential location. Multivariable modified Poisson regression analyses were performed to identify factors associated with home deaths in both periods.

Results

Among 3,010,374 individuals, 11.6% (226,571/1,959,304) and 20.8% (218,429/1,051,070) died at home before and during the pandemic, respectively. In subgroup analysis depicting the trend of in-home deaths by patient characteristics, only the age group showed a differential trend: the proportion of in-home deaths was higher among older people before the pandemic, whereas it was higher among younger people during the pandemic. The multivariable analysis revealed the excess risk of in-home deaths among people aged ≥65 years before the pandemic and among those aged <65 years during the pandemic.

Conclusions

The pandemic has increased home-based end-of-life care for terminal cancer patients, particularly younger individuals, possibly due to hospital visit restrictions. Ensuring sufficient resources for both home and hospital care is vital to allow individuals to receive end-of-life care in their preferred settings.