TRENDS IN THE TERMINAL CARE OF CANCER-PATIENTS - SOUTH-AUSTRALIA, 1981-1990

Background: The increasing numbers of cancer patients, the high costs of terminal care, and the development of palliative care services have led to a growing interest in patterns of terminal cancer care. These patterns are relevant to the formulation and evaluation of health serv ices policy. Aims: To investigate trends in the place of death of Sout h Australian cancer patients between 1981 and 1990, and to examine ass ociations of socio-demographic and clinical variables with the place o f death. Methods: Data relating to 2715 deaths attributed to cancer in 1990 were extracted from the Central Cancer Registry. To assess trend s, these data were directly standardised to the age-sex distribution o f cancer deaths in 1981 and 1985 which were investigated in a previous study. Unconditional logistic regression was used to investigate pred ictors of place of death. Results: The proportion of deaths which occu rred in major metropolitan public hospitals decreased from 40% in 1981 to 28% in 1990. Conversely, the proportion which occurred in hospice units increased from 5% to 20% over the same period. There was a decli ne in the proportion of deaths which occurred in private hospitals, bu t there was no significant change in the proportion which occurred in country hospitals or nursing homes. The proportion of deaths at home r emained around 14%. Associated with place of death were age, sex, type of malignancy, survival time from diagnosis to death, Aboriginality, and area of residence. Further research to assess the clinical appropr iateness of terminal care patterns is suggested.