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The BMJ logoLink to The BMJ
letter
. 2006 Mar 18;332(7542):668. doi: 10.1136/bmj.332.7542.668

Where patients with cancer die in Cuba

Alfredo A Espinosa-Roca 1,2, Alfredo D Espinosa-Brito 1,2, Eduardo Fernández-Casteleiro 1,2, Teresita Sabatés-Llerandi 1,2
PMCID: PMC1403279  PMID: 16543354

Editor—Gomes and Higginson show that identifying the factors influencing where terminally ill patients with cancer die is complicated.1

In 1981-2 we studied 13 105 deaths in adults (>15) in three different Cuban provinces. Only 27.0% of adult deaths due to malignant tumours occurred outside hospitals in Ciudad de La Habana, a western province that includes the capital of Cuba, compared with 60.2% in Cienfuegos, in the centre and southern part of the island, and 58.2% in Las Tunas, in the eastern side. The people who died at home were older than those in hospital, were found less in urban areas, and showed no variation by sex.2

We then studied adult mortality in the same three Cuban provinces over 10 years from 1990 to 1999. There were 36 999 deaths due to malignant tumours in Ciudad de La Habana (19.3% of all deaths), 5269 in Cienfuegos (19.9%), and 5820 in Las Tunas (21.6%). The mean ages were 67.9 (14.6) years, 67.9 (15.9), and 66.1 (16.6), respectively. Only 28.3% died at home in Ciudad de La Habana compared with 61.8% in Cienfuegos and 34.4% in Las Tunas.3

We recently carried out another study in Cienfuegos City, the capital, to investigate why so many more patients with cancer die at home in Cienfugos (unpublished data). We interviewed the relatives or proxies of a randomised sample of 226 adults (>15) who had lived in the city and died in 2003. Of 171 who were classified as terminally ill, 91 (53%) had died at home—in 58% of cases because of the patient's or relatives' choice.

For the last years of the past decade we have implemented a comprehensive programme of palliative care in primary care in Cienfuegos. The high proportion of deaths at home in patients with cancer could be related to this new service.4 Even in a highly organised national health system such as Cuba's—universal, accessible, equitable, and free to all—looking for local answers to specific conditions seems to be effective.5

Competing interests: None declared.

References

  • 1.Gomes B, Higginson IJ. Factors influencing death at home in terminally ill patients with cancer: systematic review. BMJ 2006;332: 515-21. (4 March.) [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 2.Espinosa A, Diez E, González E, Santos M. Adultos fallecidos en tres provincias cubanas (1981-1982). Algunos factores relacionados con el lugar donde ocurrió la muerte. Rev Cub Salud Pública 1989;15: 245-58. [Google Scholar]
  • 3.Espinosa A, Quintero Y, Cutiño Y, Romero AJ, Bernal JL. Mortalidad del adulto en tres provincias cubanas. In: Iñiguez L, Pérez OE. Heterogeneidad social en la Cuba actual. Havana: Ciudad de La Habana, Centro de Estudio de Salud y Bienestar Humano, Universidad de La Habana, 2004: 163-94.
  • 4.Espinosa AA, Romero AJ, Misas M, Fresneda O. Asistencia al enfermo terminal en la atención primaria de salud. Rev Finlay 2005;10 (número especial): 133-43. [Google Scholar]
  • 5.Murray SA, Boyd K, Thomas K, Higginson IJ. Developing primary palliative care. BMJ 2004;329: 1056-7. [DOI] [PMC free article] [PubMed] [Google Scholar]

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