Home or hospital? Factors associated with the place of death for advanced cancer patients in a tertiary cancer center

End-of-life care is a significant marker of dignity, comfort, and quality of care services. Determining the place of death is a pivotal aspect of palliative care provided to patients with advanced cancer. Approximately half of advanced cancer patients wish to die at home surrounded by their family and loved ones. The current study aimed to assess demographic, clinical, and service-related factors associated with the place of death among advanced cancer patients at a tertiary oncology center in Saudi Arabia. A retrospective chart review design was used to explore the factors associated with the place of death among patients diagnosed with advanced cancer at Princess Noorah Oncology Center (PNOC) in Jeddah, Saudi Arabia. The primary outcome was death at PNOC versus death outside PNOC. The analysis included the data of 465 patients. Of these patients, 285 (61.3%) died at PNOC, while 180 (38.7%) died outside PNOC (174 documented as home deaths and six annotated as transfers to another hospital). Referral to home healthcare services was strongly associated with an increased likelihood of death outside PNOC (OR = 14.2, 95% CI: 5.90–37.6, p < .001). Conversely, patients with nine or more medications had markedly lower odds of dying outside PNOC (OR = 0.10, 95% CI: 0.03–0.30, p < .001). No cancer type showed statistically significant associations in the main model. Hypertension (OR = 0.37, 95% CI: 0.16–0.84, p = .019), a history of cerebrovascular accident (CVA; OR = 0.24, 95% CI: 0.06–0.91, p = .041), and support or comfort care code status (OR = 0.02 and 0.03, respectively; both p < .001) were each independently associated with lower odds of death outside PNOC. More than one-third of patients died outside PNOC, predominantly at home, and home healthcare referral was strongly associated with death outside PNOC. In contrast, polypharmacy, hypertension, cerebrovascular accident, and support or comfort care status were associated with an increased likelihood of death in the hospital setting. These findings highlight the interplay between clinical and patient-related factors.