Characteristics and Pattern of Mortality in Cancer Patients at a Tertiary Care Oncology Center: Report of 259 Cases

Background: Little is known about mortality statistics of hospitalised cancer patients from developingcountries. This paper describes the distribution of causes of death in various malignancies, status of malignancy atthe time of death, type and intent of therapy received by the cancer patient prior to death and nature of infectionsin terminal cancer patients who died in hospital. We also aimed to study discrepancies in mortality reporting interms of death certificate at our center and tried to analyse possible causes. Results : Data for 259 consecutivedeaths in hospitalized cancer patients in a calendar year were analysed. Of all these, 147 (57%) were cases ofsolid tumors, 107 (41%) were cases of hematological malignancies and 5 (2%) were other or undiagnosed cases.Median duration of hospital stay prior to death was 7 (1-106) days. Sepsis/multi organ dysfunction syndrome(MODS) was commonest immediate cause of death 118/259 (45.2%) followed by progressive malignancy in64/259 (24.7%) cases. Only 13/267 (5%) patients died with controlled cancer. Some 184 (71.3%) deaths occurredwithin 90 days of any form of anticancer treatment of which more than three fourths (77.2%) occurred afterchemotherapy. Among these chemotherapy related deaths, 63 were febrile neutropenic deaths, with the commonestsite of infection in the lungs, and positive blood culture was found in 18 (28%) cases. There were discrepanciesin information derived from death certificates and from case records in 84 (32%) cases. Most of these weredue to the use of ambiguous terms like cardio-respiratory arrest as a cause of death in the death certificate.
Conclusion: It is important to audit mortality data on a regular basis as this can provide valuable insight intohospital practice and may help to identify preventable causes of mortality. Mortality record keeping is anotherimportant aspect as variable practices in this area may have implications for cancer mortality reporting andthis may ultimately lead to erroneous cancer epidemiology.