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Preference and actual place-of-death in advanced cancer: prospective longitudinal study
  1. Talita Caroline de Oliveira Valentino1,
  2. Carlos Eduardo Paiva1,2,
  3. Marco Antonio de Oliveira1,
  4. David Hui3,
  5. Eduardo Bruera4,
  6. Miguel Julião5 and
  7. Bianca Sakamoto Ribeiro Paiva1
  1. 1 GPQual - Research Group on Palliative Care and Quality of Life, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
  2. 2 Department of Clinical Oncology, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
  3. 3 Palliative Care, MD Anderson Cancer Center, Houston, Texas, USA
  4. 4 Palliative Care & Rehabilitation Medicine, UT M. D. Anderson Cancer Center, Houston, Texas, USA
  5. 5 Equipa Comunitária de Suporte em Cuidados Paliativos de Sintra, Lisboa, Portugal
  1. Correspondence to Dr Bianca Sakamoto Ribeiro Paiva, Barretos Cancer Hospital, Barretos, São Paulo 14780-000, Brazil; bsrpaiva{at}


Objectives To evaluate the preferred place-of-death (PPoD) among patients with advanced cancer over time, and the concordance between preferred and actual place-of-death.

Methods Prospective cohort study. A total of 190 patients with advanced cancer and their caregivers (n=190) were interviewed every 3 months, from study enrolment to 12 months (M0, M1, M2, M3, M4). PPoD data were obtained under four different end-of-life scenarios: (1) severe clinical deterioration without further specification; (2) clinical deterioration suffering from severe symptoms; (3) clinical deterioration receiving home-based visits; and (4) clinical deterioration receiving home-based visits and suffering from severe symptoms.

Results Home was the most common PPoD over time among patients in scenarios 1 (n=121, 63.7%; n=77, 68.8%; n=39, 57.4%; n=30, 62.5%; n=23, 60.5%) and 3 (n=147, 77.4%; n=87, 77.7%; n=48, 70.6%; n=36, 75.0%; n=30, 78.9%). PPoD in palliative care unit (PCU) and hospital were most frequent at baseline in scenario 2 (n=79, 41.6%; n=78, 41.1%), followed by hospital over time (n=61, 54.5%; n=45, 66.2%; n=35, 72.9%; n=28, 73.7%). During the curse of illness, 6.3% of patients change their PPoD in at least one of end-of-life scenario. About 49.7%, 30.6% and 19.7% of patients died in PCU, hospital and home, respectively. Living in rural area (OR=4.21), poor health self-perception (OR=4.49) and pain at the last days of life (OR=2.77) were associated with death in PPoD. The overall agreement between last preference and actual place-of-death was 51.0% (k=0.252).

Conclusion Home death was not the preferred place for a large number of patients when this option was presented within a clinical context scenario. The PPoD and actual place-of-death were depending on the clinical situation.

  • cancer
  • end of life care
  • supportive care
  • clinical decisions

Data availability statement

No data are available. ‘Not applicable.

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Data availability statement

No data are available. ‘Not applicable.

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  • X @CEPaiva

  • Contributors Design: TCdOV, CEP, BSRP. Data collection: TCdOV. Data analysis: MAdO, TCdOV, BSRP, CEP. Draft manuscript: TCdOV, BSRP, CEP, MAdO, DH, EB, MJ. Guarantor: BSRP. All authors edited and approved the final version of the paper.

  • Funding TCOV received an individual PhD’s degree scholarship from the São Paulo Research Foundation (FAPESP grant number 2018/08728-7). BSRP - CNPq Research Productivity Fellow Level 2 - CNPq Grant number 313601/2021-6.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.