Keeping Cancer Patients Out of the Hospital at the End of Life

Caring for patients at the end of life is perhaps the most noble of the medical arts, and for oncologists, it is a daily reality. All too often, cancer takes a deadly toll, and oncologists are actively engaged in the management of the dying patient. Such care includes treatment with appropriate therapies and referral to specialists for appropriate palliative interventions. But these treatment decisions are the “easy ” part of medical care for the clinical team. The more challenging tasks lie in communicating to patients and their families what can—and cannot—be achieved and what the future is likely to hold. Those conversations depend on familiarity with the disease but also on familiarity with the person who has the disease: understanding their preferences, social supports, financial circumstances, cognitive function, and personality. Patients know a lot about one aspect of end-of-life care, which is their own preference for the place of death. Multiple surveys from many different countries have asked people where they would prefer to spend their final days. Across all cultures and nationalities, the vast majority of cancer patients want to die at home.1 Dying at home is not only the preferred option “in theory, ” or according to preference surveys. It is also, for most, th