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Health Series: Research Spotlight

Improving end of life care for poorest cancer patients could save NHS £4.6 million a year

Research found that people with the four most common cancers living in the most deprived parts of England are more likely to be admitted to hospital as an emergency in the last 6 months of their lives

by George Wigmore (Senior Communications Officer)

End of life hospital care for cancer patients in the most deprived areas of England costs the NHS an extra £4.6million every year, according to new research by City, University of London and the Economic and Social Research Institute, funded by Macmillan Cancer Support.

The study, released today in Health Affairs, analysed data from England’s National Cancer Registry on 250,000 people and found that people 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 to hospital as an emergency in the last 6 months of their lives, which is increasing the cost of their care. Cancer patients from the most deprived areas also spend longer in hospital following an emergency admission.

The paper examines how the cost of hospital care for cancer patients in the last six months of their lives varies by socioeconomic deprivation. It found that:

  • People with cancer in the most deprived areas of England spend more days in hospital after an emergency admission, compared with those from the least deprived areas:
    • The average person with colorectal cancer spends 4 more days in hospital
    • The average woman with breast cancer spends 3 more days in hospital
    • The average man with prostate cancer spends 5 more days in hospital
    • The average person with lung cancer spends 2 more days in hospital
  • This means that hospital care during the last six months of life for people with cancer living in the most deprived areas of England costs:
    • £526 more per patient for breast cancer
    • £564 more per patient for prostate cancer
    • £456 more per patient for bowel cancer

In total, hospital care for people in the most deprived areas works out at around £4.6 million more per year for these four cancer types alone.

Macmillan Cancer Support warns that the study could highlight ‘unacceptable’ variation 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 advanced cancer 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, says:

“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’s a huge financial implication of poor access to care for dying people. That’s why it’s vitally important for the new Government to keep its promises about improving end of life care – which it committed to a year ago today, 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, says:

“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.”

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