| dc.description.abstract | INTRO: Cancer is the leading cause of death in Norway, accounting for a quarter of all deaths. Quality end-of-life care is an important aspect of treatment, and Norway's palliative care policy highlights the importance of providing care in the individual's preferred location, which is often at home. However, many patients live in rural municipalities with long distances to access healthcare services, which may be a barrier to at-home care. Main objectives of this study were to identify factors associated with time spent at home and in the hospital in the last six months of life, and explore the association between geographic factors and end-of-life care location. METHODS: This study utilized data from four national registries, including the Norwegian Causes of Death Registry, Norwegian Patient Registry (NPR), the Norwegian Registry for Primary Healthcare (NRPC), and Statistics Norway. The study population consisted of individuals who died of cancer between 2019 and 2021, identified from the Causes of Death Registry. Variables associated with days at home and in hospital in the last six months of life were assessed using a two-part model using logistic regression and OLS. Sociodemographic/medical variables included in regression analyses were sex, age, marital status, education level, income, year of death and comorbidity. Geographic factors were municipality population size, county of residence, and distance to the nearest hospital. Stratified analyses were conducted according to sex. RESULTS: From 2019 – 2021, 32,710 individuals died from cancer and were included in this study. The majority were aged 71-80 (55%), male (53%) married, had secondary school education (45%), and made between 200 – 400 000 NOK/year. Most (72%) had mild or moderate comorbidities (<5 CCI), and lived the 20% largest municipalities (68%). The average distance to the nearest hospital was 31.3 kilometers. Significant positive associations were identified between days at home and male sex, lower age, being married or having a partner, higher education and income. Larger distances to hospital were associated with fewer days at home and hospital, and more time in long-term care. Agder and Viken county had the highest number of days at home, and Oslo county had the highest number of days in hospital. DISCUSSION: Inaccessibility due to geographic factors is a central issue facing the healthcare sector, and policies regarding EoL care for individuals with cancer needs to consider these inequalities. Our findings shed light on the barriers faced by individuals residing in rural or remote areas in accessing healthcare services. Individuals living in urban areas may have better access to short-term facilities that can periodically provide relief and support for the sick individual and their family. These findings highlight the influence of geographic factors on care patterns at the end of life for cancer individuals in Norway. CONCLUSION: Easier access to healthcare services in terms of place of residence, including living close to a hospital and in an urban location, are independent predictors of more time spent at home at EoL and in hospital. Understanding these patterns can help identify areas for improvement in EoL healthcare services | nob |