UNLABELLED: Chronic obstructive pulmonary disease and lung cancer are leading causes of death with comparable symptoms at the end of life. Cross-national comparisons of place of death, as an important outcome of terminal care, between people dying from chronic obstructive pulmonary disease and lung cancer have not been studied before. We collected population death certificate data from 14 countries (year: 2008), covering place of death, underlying cause of death, and demographic information. We included patients dying from lung cancer or chronic obstructive pulmonary disease and used descriptive statistics and multivariable logistic regressions to describe patterns in place of death. Of 5,568,827 deaths, 5.8% were from lung cancer and 4.4% from chronic obstructive pulmonary disease. Among lung cancer decedents, home deaths ranged from 12.5% in South Korea to 57.1% in Mexico, while hospital deaths ranged from 27.5% in New Zealand to 77.4% in France. In chronic obstructive pulmonary disease patients, the proportion dying at home ranged from 10.4% in Canada to 55.4% in Mexico, while hospital deaths ranged from 41.8% in Mexico to 78.9% in South Korea. Controlling for age, sex, and marital status, patients with chronic obstructive pulmonary disease were significantly less likely die at home rather than in hospital in nine countries. Our study found in almost all countries that those dying from chronic obstructive pulmonary disease as compared with those from lung cancer are less likely to die at home and at a palliative care institution and more likely to die in a hospital or a nursing home. This might be due to less predictable disease trajectories and prognosis of death in chronic obstructive pulmonary disease. LUNG DISEASE: IMPROVING END-OF-LIFE CARE: Structured palliative care similar to that offered to cancer sufferers should be in place for patients with chronic lung disease. Joachim Cohen at Vrije University in Brussels and co-workers examined international death certificate data collected from 14 countries to determine place of death for patients with lung cancer and chronic obstructive pulmonary disease (COPD). While patients with COPD suffer similar symptoms to lung cancer in their final days, few COPD patients receive palliative care or achieve the common wish of dying at home. This may be partly due to the inherent unpredictability of final-stage COPD compared with lung cancer. Cohen's team found that, with the exception of Italy, Spain, and Mexico, patients with COPD were significantly more likely to die in hospital than at home. They highlight the need for improved COPD palliative care provision.

Aging Research Center Karolinska Institutet and Stockholm University Stockholm Sweden

Cancer Prevention and Research Institute ISPO Clinical and Descriptive Epidemiology Unit Florence Italy

Center for Palliative Care 3rd Faculty of Medicine Charles University Prague Prague Czech Republic

Department of Family Medicine and Chronic Care Vrije Universiteit Brussel Brussels Belgium

Department of Medical Oncology Ghent University Ghent Belgium

Dongduk Women's University Health Sciences Seoul Republic of Korea

EMGO Institute for Health and Care Research Public and Occupational Health and Palliative Care Expertise Centre VU Medical Centre Amsterdam The Netherlands

Faculty of Nursing University of Alberta Edmonton AB Canada

Hammond Care and University of Sydney Sydney Australia

Ministry of Health Government of Andalusia Seville Spain

National Observatory of End of Life Care Paris France

The University of Texas MD Anderson Cancer Center Houston TX USA

University of Pécs Medical School Pécs Hungary

University of Southampton Health Sciences Southampton UK

University of Washington Cambia Palliative Care Center of Excellence Division of Gerontology and Geriatrics Seatle WA USA

Vrije Universiteit Brussel and Ghent University End of Life Care Research Group Brussels Belgium

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