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Hospital remains most common place of death for cancer patients in England

In England, hospital is still the most common place for patients with cancer to die but an increase in home and hospice deaths since 2005 suggests that the National End of Life Care Programme (a Programme to promote the rollout of national end-of-life care initiatives) has helped more people to die at their preferred place of death, according to a UK study funded by the National Institute for Health Research Health Services and Delivery Research (NIHR HS&DR) Programme, published in this week’s PLOS Medicine.

In a large analysis led by Dr Wei Gao and Professor Irene Higginson from King’s College London, the authors used death registration data collected by the Office of National Statistics to identify all 2.28 million adult cancer deaths in England between 1993 and 2010.

Professor Higginson says: ‘This internationally important study, supported by NIHR, shows a likely positive effect of the National End of Life Strategy on enabling more patients with advanced cancer to die at home if they wish. There is a sustained reversal of earlier trends, coinciding with the implementation of the National Strategy. However, there are still many patients with advanced cancer who die in hospital, which is their least preferred place. We have identified new at risk groups, especially people who are single, widowed or divorced,  along with known groups such as haematological cancer, lung cancer, older age and deprivation, that should be a focus for end-of-life care improvement and future strategy’.

Throughout the study period, the authors found that hospital was the commonest place of death—48% of cancer deaths—whereas 24.5% deaths of cancer patients occurred at home and 16.4% occurred in hospices.

However, the authors found that the proportion of home deaths increased after 2005 whereas the proportion of hospital deaths declined. The proportion of deaths in hospices also increased over the study period. The National End of Life Care Programme in England was launched in November 2004.

Importantly, the authors also found that being single, widowed or divorced was linked with a higher chance of dying in hospital than being married. Being aged over 75 years was also linked to a higher chance of dying in hospital than in younger age groups although older people were more likely to die at home or in a hospice after 2006 than in earlier periods. Cancer type also played an important role in place of death: for example, patients who died from blood cancer and lung cancer were more likely to die in hospital than patients with colorectal cancer throughout the study period.

The authors say: “This large-scale, population-based study found that hospitals remain the most common place of death for patients with cancer. Following a prolonged period of plateau, there was a steady downward trend in hospital deaths (about 50%) from 2005 onwards. The pattern was mirrored by increasing home deaths.”

They continue: “This trend coincides with the launch of a National End of Life Care Programme in November 2004 in England, which was based on research evidence about patient preferences and possible solutions.

The authors conclude: “More efforts are needed to reduce hospital deaths. Healthcare facilities should be improved and enhanced to support the increased home and hospice deaths. ”

They add: “People who are single, widowed or divorced should be a focus for end-of-life care improvement, along with known at risk groups such as haematological cancer, lung cancer, older age and deprivation.”  

Read the journal article in PLOS Medicine

See the GUIDE_CARE project page

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The NIHR Health Services and Delivery Research (HS&DR) Programme is managed by the NIHR Evaluation, Trials and Studies Coordinating Centre (NETSCC). NETSCC is part of the University of Southampton funded by the NIHR, with specific contributions from the CSO in Scotland and NISCHR in Wales and the HSC R&D Division, Public Health Agency in Northern Ireland.

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