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England’s poorest cancer patients have limited access to end of life care

Author: Leila Hawkins
06 July 2017

New research published today states that cancer patients in the poorest parts of England are more likely to be admitted to hospital as an emergency in the last six months of their lives, rather than access end of life care services.

The research has been carried out by City, University of London and the Economic and Social Research Institute, and funded by Macmillan Cancer Support.

The study used data from England’s National Cancer Registry of 250,000 people, and found that those with the four most common cancers (breast, bowel, prostate, and lung cancer) living in the most deprived parts of England are more likely to be admitted as emergencies and spend more days in hospital after an emergency admission, compared with those from the least deprived areas. End of life care in hospitals for cancer patients in the poorest areas of England is costing the NHS an extra £4.6 million every year.

Macmillan Cancer Support warns that the study could highlight variations in access to specialist end of life care, meaning that the most deprived people with cancer are more likely to rely on emergency care when complications arise. The charity believes that providing people with the support they need, as well as the opportunity to plan ahead for the end of their lives could help avoid costly and distressing emergency admissions.

Adrienne Betteley, Macmillan Cancer Support’s Specialist Advisor for End of Life Care, said:

“Access to the right care and support when you have advanced cancer should not depend on where you are from, or your socioeconomic background. Yet too many people from the poorest parts of England are having to rely on emergency care towards the end of their lives, which can be incredibly traumatic for both patients and their families.”

“Alongside the great human cost, there is a huge financial implication of poor access to care for dying people. That is why it is vitally important for the new Government to keep its promises about improving end of life care – which it committed to a year ago, and repeated in its General Election manifesto.”

Dr Mauro Laudicella, Senior Lecturer in Health Economics at City, University of London and one of the authors of the paper, said:

“What our study shows is that there are significant disparities in end of life hospital treatment costs for cancer patients in England, largely due to a greater use of emergency care in patients from most deprived areas. In contrast, use of elective care is more prevalent in patients from less deprived areas of England.”

“Managing the health care needs of patients from most deprived areas more effectively could potentially reduce such disparities in costs, through the use of planned rather than emergency care, and a more effective use of palliative care. By investing in patients early on in their cancer journey, the NHS can slow down the spiralling cost of care, and ensure that in the future everyone who has cancer will be able to get the care they need.”

Commenting in response, Carole Walford, Chief Clinical Officer of Hospice UK, said:

“This research highlights the stark inequities in end of life care for some cancer patients. There is an urgent need for investment to support services to collaborate across all care settings and bring good end of life care to all who need it, in the setting of their choice.

“Repeat emergency hospital admissions can be highly disruptive and stressful for patients and their families and place considerable strain on an already over-stretched NHS. The use of emergency care for those requiring end of life care should be appropriately anticipated and not a default option to support a lack of adequate community provision.

“Access to the right care should not be determined by someone’s postcode or socio-economic standing. Hospice UK is committed to tackling inequality to ensure that no-one is disadvantaged towards the end of their life. We are working to extend hospice care to more people and, where there is a need to access emergency care, to support other care providers to provide the best care possible within the limited resource available”.

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