Hospitals Worse than Home for Cancer Survival

Hospitals provide a significant amount of technical care for critical care cases. They can provide immediate surgical care and focused attention.

But most people insist they don’t want to die in a hospital. Being surrounded by sterile surfaces and being plugged into monitoring machines repulses most of us. Most of us simply want to be in our own bed when we are sick. We want to be able to connect with our family and have the comfort of privacy during our illness.

Yet our doctor may insist that we’ll live longer if we go to the hospital. This may certainly be true for critical care that requires surgery or other interventions.

But as new research finds, its not true for those with terminal cancer.

Cancer patients live longer at home

A large multi-hospital study followed 2,069 cancer patients from Japan. They had terminal cancer and were expected to die soon. Of these, 1,582 patients stayed in the hospital and received the focused care of doctors and nurses. The remaining 487 cancer patients remained at home and received home-based care. There was no difference regarding the seriousness of their cancers.

The researchers found that those patients who stayed at home lived significantly longer than the patients who stayed at the hospital. This was after adjusting for any other factors that may have contributed to their longevity.

Those with a worse prognosis lived 30 percent longer when they stayed at home. Across the board: After calculating the hazard analysis based on survival rates, the research found that staying at home results in a 14 percent increased risk of survival. That is, compared to staying at the hospital.

The study was conducted in conjunction with cancer treatment centers at several major hospitals. It was published in the American Cancer Society’s journal Cancer.

Lead researcher Jun Hamano, MD of Japan’s University of Tsukuba commented:

“The cancer patient and family tend to be concerned that the quality of medical treatment provided at home will be inferior to that given in a hospital and that survival might be shortened; however, our finding—that home death does not actually have a negative influence on the survival of cancer patients at all, and rather may have a positive influence—could suggest that the patient and family can choose the place of death in terms of their preference and values,” said Dr. Hamano. “Patients, families, and clinicians should be reassured that good home hospice care does not shorten patient life, and even may achieve longer survival.”

Hospital-acquired infections kill thousands

This study may not include a major issue that takes place among many U.S. hospitals – superbug infections. That is, that many people will die in the hospital specifically because they are infected with a hospital-acquired infection.

According to the Centers for Disease Control, about 772,000 people were infected during a visit to an acute care hospital in 2011. And some 75,000 people died of a hospital-acquired infection during that year.

This is not to say that there has been significant efforts to decrease these outrageous statistics. The CDC also reports decreases among hospital infections. MRSA (methicillin-resistant Staphylococcus aureus) infections fell by 13 percent between 2011 and 2014. And Clostridium difficile infections dropped by 8 percent during this time. And surgical site infections and others have dropped in recent years. That’s the good news.

The bad news is that many of these hospital-acquired infections have gotten harder to control with antibiotics. Those superbugs have become more super. So fewer antibiotics are able to treat them.

Medical errors in the hospital

The other bad news is that medical errors are rampant in hospitals. A 2010 study published in the New England Journal of Medicine studied this at length. They investigated admissions between 2001 and 2007 at 10 hospitals in North Carolina. They found that out of 2,341 patients, there were 588 medical errors that caused harm. This equated to 25 harmful medical errors out of every 100 patient admissions.

Of these mistakes, 186 were related to procedures, 162 were related to medications, 87 were related to hospital-acquired infections, 59 were related to therapies, and 7 were related to diagnoses.

Of these 588 medical errors, 245 required further treatment. And 251 required extended hospitalization. Worse, 50 of these were life-threatening, and 14 caused the death of the patient. And 17 of the harms – or about 3% – caused permanent injury.

A full 63 percent of these medical errors were classified as preventable by the researchers.

A 2010 report from the U.S. Department of Health and Human Services found that in one in seven people experienced an adverse event in the hospital. This equated to 13.5 percent of every hospital visit: And 134,000 adverse events in just one month.

This means 1.6 million people each year have an adverse event in the hospital.

They also found that 1.5 percent of Medicare patients experienced an adverse event in the hospital that contributed to their death. This calculated to a full 15,000 patient deaths in a month – or 180,000 deaths each year. This is where an event occurring in the hospital contributed to the death of a patient.

Hospitals are not bad

Doctors and nurses work hard at hospitals throughout the world. And countless patients have survived their illnesses and injuries by visiting the hospital. They receive surgeries and medications that extend their lives. So let’s not miss their benefits. We are grateful for their hard work and dedication. And grateful for the some of the technologies hospitals offer.

But when we don’t absolutely have to be in the hospital, let’s open a bed for someone who needs it worse. Recovering at home by using out-patient care and home nursing care can not only be cheaper: It may extend our life or the life of a family member a little. And it might allow for some respite and spiritual awakening that perhaps the sterile surroundings of a hospital may not support.

REFERENCES:

Jun Hamano, Takashi Yamaguchi, Isseki Maeda, Akihiko Suga, Takayuki Hisanaga, Tatsuhiko Ishihara, Tomoyuki Iwashita, Keisuke Kaneishi, Shohei Kawagoe,Toshiyuki Kuriyama, Takashi Maeda, Ichiro Mori, Nobuhisa Nakajima, Tomohiro Nishi, Hiroki Sakurai, Satofumi Shimoyama, Takuya Shinjo, Hiroto Shirayama, Takeshi Yamada, Tatsuya Morita. A multicenter cohort study on the survival time of cancer patients dying at home or in hospital: Does place matter? CANCER; Published Online: March 28, 2016 (DOI: 10.1002/cncr.29844)

CDC. Healthcare-associated infections: HAI Data and Statistics. Accessed Mar 30, 2016

Landrigan CP, Parry GJ, Bones CB, Hackbarth AD, Goldmann DA, Sharek PJ. Temporal trends in rates of patient harm resulting from medical care. N Engl J Med. 2010 Nov 25;363(22):2124-34. doi: 10.1056/NEJMsa1004404. Erratum in: N Engl J Med. 2010 Dec 23;363(26):2573. PubMed PMID: 21105794.

Levinson D. Adverse Events in Hospitals: National Incidence Among Medicare Beneficiaries. Dept of Health and Human Services. Nov. 2010. OEI-06-09-00090.