End of life care for urological cancer patients

Abstract

Background: Each year around 15,000 men and 2900 women die from a urological cancer. The trajectory at end of life can be long and progressive or punctuated by acute events. Nonetheless those who die from urological cancer share some certain common disease manifestations that necessitate input from secondary care. Methods: All records of people dying from a urological cancer in 2004–2013 were extracted from Office for National Statistics and National Cancer Registration and Analysis Service databases. Records were linked to hospital episode statistics to analyse patterns of admitted patient care, outpatient attendances and emergency department attendances. Results: There has been a progressive decline in the proportion of deaths in hospital, from 47% to 35% of deaths. There has been a notable increase in care home deaths, which have risen from 13% to 19% of deaths and overtaken deaths in a hospice. Despite an only modest rise in total deaths from urological cancers (15,573 per year 2004–2006; 16,921 per year 2011–2013) there has been a much larger increase in secondary care activity in the last year of life. The largest change was for outpatient attendances, where the mean number increased from 3.0 to 13.6 per person. Conclusion: Differences in age at death may account for some of the differences in place of death. Those dying at an older age will be more likely to require care for comorbidities or frailty, and hence be in a care home already. The large increase in outpatient activity could reflect attempts to manage more end of life care without hospital admissions. Yet inpatient activity has increased more quickly than the number of deaths. The increase in outpatient activity may instead be due to developments in treatment for advanced cancer, and prostate cancer in particular, being offered to patients close to the end of life.