How were place of death trends for cancer patients affected by the COVID-19 pandemic? An international death certificate study

Abstract

Background and objective: During the pandemic, health systems had to respond to the needs of COVID-19 patients, while caring for patients with other conditions, including cancer. Hospitals/health institutions and home are relevant places of death (PoD) globally. We aim to examine changes in PoD trends for cancer patients, comparing pre- and pandemic years.

Methods: We sought national PoD data from vital registries of 47 countries varied in UN Regions. We describe the distribution of PoD (focused on hospital/health institution and home) for cancer patients [ICD-10 codes: C0-C97 (except C91-95)] from 2015 to 2021, examining variations by year, age (0-17 or ≥18) and country. Pandemic years include 2020 and, where available, 2021.

Results: Preliminary data shows that among 3,005,530 deceased from cancer (99.7% aged ≥18y) across 19 responding countries so far (15 countries providing 2021 data), home deaths increased in pandemic years (range per year: 40%-45%) compared to pre-pandemic (33%-35%). Inversely, deaths in hospitals/health institutions decreased (54%-56% to 43%-49%). Sub-analysis of the pediatric group (9,894 deceased) also showed increasing home death (32%-34% to 39%-39%). Consistently, for 18 out of the 19 countries the percentage of hospital/health institution deaths for cancer patients decreased during the pandemic (-11% in the country with largest decrease; smallest: -2%), while for 17 out of 19 countries the percentage of those dying at home increased (12% in country with largest increase; smallest: 1%).

Conclusion: An increase in home deaths appears to have occurred among cancer patients in the COVID-19 pandemic. A more detailed and homogeneous classification of PoD would provide stronger cross-country comparisons, as what is classified in each category varies. It is important to monitor if this shift in PoD is kept or reverts beyond 2021, due to the implications for the allocation of health resources to care for the dying.