Where patients with cancer die in Cuba

doi:10.1136/bmj.332.7542.668

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Alfredo A Espinosa-Roca, coordinator, palliative care programme (espinosa@perla.inf.cu),
Alfredo D Espinosa-Brito, professor,
Eduardo Fernández-Casteleiro, doctor,
Teresita Sabatés-Llerandi, doctor

Municipal Health Division of Cienfuegos, Ave 56 No 2917 altos, Cienfuegos 55100, Cuba
Teaching Hospital “Dr Gustavo Aldereguia Lima,” Cienfuegos, Ave 5 de Septiembre and Calle 51A, Cienfuegos 55100

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 …