Place of death and its determinants for patients with cancer in Singapore: an analysis of data from the Singapore Cancer Registry, 2000-2009

J Palliat Med. 2011 Oct;14(10):1128-34. doi: 10.1089/jpm.2011.0092. Epub 2011 Oct 3.


Aims: To describe the place of death for patients with cancer in Singapore from 2000 to 2009, and determinants of death at home and in in-patient hospice compared to death in hospital.

Method: Cross-sectional analysis of all patients registered with the Singapore Cancer Registry who had died in the study period (N=52120). Places of death were grouped as homes, in-patient hospices, hospitals and others. For determinants of death at home and in in-patient hospice, covariates adjusted for in logistic regression analyses were age group, gender, ethnic group, primary tumour site, stage at diagnosis, duration and cause of death.

Results: In the 10-year period, 52.9% of patients with cancer had died in the hospital, 30.3% died at home and 10.7% in in-patient hospice. Determinants of death at home were older age, female (odds ratio OR 1.23, 95% confidence interval, CI 1.17-1.29), Malay (OR 2.28, 95% CI 2.13-2.44), cancers of the colo-rectum, liver, stomach, pancreas and nasopharynx (compared to lung cancer), duration of illness of 1-5 years (OR 1.40, 95% CI 1.34-1.48), primary cause of death being 'neoplasms' (OR 2.97, 95% CI 2.79-3.17). Determinants of death in in-patient hospice were older age, distant metastasis (OR 1.35, 95% CI 1.21-1.50) and primary cause of death being 'neoplasms' (OR 20.07, 95% CI 16.05-25.09).

Conclusion: Knowledge about place of death and its determinants will facilitate the planning of healthcare services to enable patients with terminal cancer to die at home and in in-patient hospices, thereby avoiding inappropriate hospitalization at the end of life.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Attitude to Death*
  • Confidence Intervals
  • Cross-Sectional Studies
  • Female
  • Geography
  • Health Knowledge, Attitudes, Practice*
  • Health Services / statistics & numerical data
  • Hospice Care / methods
  • Hospice Care / psychology*
  • Humans
  • Male
  • Middle Aged
  • Neoplasms*
  • Odds Ratio
  • Patient Satisfaction*
  • Registries
  • Sex Factors
  • Singapore