Real-World Data on Home End-Of-Life Care for Elderly Cancer Patients: A Yokohama Original Medical Database-Based Retrospective Analysis

Abstract Background Cancer incidence is expected to increase with population aging, making the availability of places for treating terminal cancer patients a pressing issue. Thus, home medical care is expected to play a crucial role. However, real-world big data on the actual state of home end-of-life care in Japan are limited. We aimed to clarify the real-world state of home end-of-life care for elderly cancer patients using data from an administrative database. Methods We analyzed the Yokohama Original Medical Database, which included 2,486,834 people and 29,411,895 medical invoices in 2014 and 2015. Data of target patients were extracted based on three criteria: age ≥ 65 years, malignant neoplasm diagnosis, and having a billing code of home end-of-life care. Medical fee points, including data related to home medical care, emergent admission, and survival time at home, were also analyzed. Results Overall, 1,323 people (554 and 769 aged < 80 and ≥ 80 years, respectively; males, 59.2%) had planned to receive home end-of-life care. The < 80-year group had more frequent emergent home visits than the ≥ 80-year group (p < 0.001), but the number of monthly home visits was similar between the two groups (p = 0.267). The average overall survival time at home was 3.9 ± 4.4 months, with the < 80-year group having a shorter survival time than the ≥ 80-year group (p < 0.001). Conclusions Terminal cancer patients aged ≥ 80 years were less dependent on home medical care and had better prognosis at home than terminal cancer patients aged < 80 years did. Our results can provide the basis for providing home medical care through a community-based integrated care system and for evidence-based policymaking.