Why do cancer patients die? A decade of experience on trends, profile, causes, and timing of deaths in India

SETTING Medical oncology department in a tertiary care hospital, South India. OBJECTIVE To evaluate trends, profile, causes, and timing of inpatient deaths among cancer patients between 2016 and 2025. DESIGN A cohort study using secondary data from electronic medical records. RESULTS There were 474 inpatient deaths. Despite an 11-fold increase in annual admissions (119 to 1,355), inpatient mortality rates remained relatively stable (range 4%–10%). Mean age at death was 63 years ( + 12), 64% were male, 73% had metastases, and 84% had poor performance status. Most patients (78%) were emergency admissions, 41% utilised palliative care services, and 75% consented to no end-of-life support. Leading immediate causes of death were cancer progression (57%), organ failure (21%), and sepsis (15%), and the leading underlying cause of death was cancer progression (83%). Median time from admission to death was 5 days (interquartile range: 2–10). Admission for treatment-related complications (adjusted relative risk [aRR]: 10.9, 95% confidence interval [CI]: 3.7–32.3) and no consent for end-of-life support (aRR: 2.5, 95% CI: 1.1–6.0) predicted treatment-related deaths, while recent systemic therapy (aRR: 0.7, 95% CI: 0.5–0.97) protected against early death. CONCLUSION Cancer progression predominates as the cause of inpatient mortality. Despite increasing admissions over 10 years, inpatient mortality rates remained stable. Nevertheless, preventing treatment-related deaths and integrating palliative care early remain critical quality-of-care priorities.