Intensity of care in cancer patients in the last year of life: a retrospective data linkage study

Xhyljeta Luta; Katharina Diernberger; Joanna Bowden; Joanne Droney; Peter S Hall; Joachim Marti

doi:10.1038/s41416-022-01828-0

Intensity of care in cancer patients in the last year of life: a retrospective data linkage study

Xhyljeta Luta, Katharina Diernberger, Joanna Bowden, Joanne Droney, Peter S Hall, Joachim Marti

Research output: Contribution to journal › Article › peer-review

Abstract / Description of output

Background: Delivering high-quality palliative and end-of-life care for cancer patients poses major challenges for health services. We examine the intensity of cancer care in England in the last year of life. Methods: We included cancer decedents aged 65+ who died between January 1, 2010 and December 31, 2017. We analysed healthcare utilisation and costs in the last 12 months of life including hospital-based activities and primary care. Results: Healthcare utilisation and costs increased sharply in the last month of life. Hospital costs were the largest cost elements and decreased with age (0.78, 95% CI: 0.73–0.72, p < 0.005 for age group 90+ compared to age 65–69 and increased substantially with comorbidity burden (2.2, 95% CI: 2.09–2.26, p < 0.005 for those with 7+ comorbidities compared to those with 1–3 comorbidities). The costs were highest for haematological cancers (1.45, 95% CI: 1.38–1.52, p < 0.005) and those living in the London region (1.10, 95% CI: 1.02–1.19, p < 0.005). Conclusions: Healthcare in the last year of life for advanced cancer patients is costly and offers unclear value to patients and the healthcare system. Further research is needed to understand distinct cancer populations’ pathways and experiences before recommendations can be made about the most appropriate models of care.

Original language	English
Pages (from-to)	712-719
Journal	British Journal of Cancer
Volume	127
Issue number	4
Early online date	11 May 2022
DOIs	https://doi.org/10.1038/s41416-022-01828-0
Publication status	Published - 1 Sept 2022

Keywords / Materials (for Non-textual outputs)

Humans
Infant, Newborn
Information Storage and Retrieval
Neoplasms/therapy
Palliative Care
Retrospective Studies
Terminal Care

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s41416-022-01828-0
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Cite this

@article{772bbf05389e405685636522dbd0e9d2,

title = "Intensity of care in cancer patients in the last year of life: a retrospective data linkage study",

abstract = "Background: Delivering high-quality palliative and end-of-life care for cancer patients poses major challenges for health services. We examine the intensity of cancer care in England in the last year of life. Methods: We included cancer decedents aged 65+ who died between January 1, 2010 and December 31, 2017. We analysed healthcare utilisation and costs in the last 12 months of life including hospital-based activities and primary care. Results: Healthcare utilisation and costs increased sharply in the last month of life. Hospital costs were the largest cost elements and decreased with age (0.78, 95% CI: 0.73–0.72, p < 0.005 for age group 90+ compared to age 65–69 and increased substantially with comorbidity burden (2.2, 95% CI: 2.09–2.26, p < 0.005 for those with 7+ comorbidities compared to those with 1–3 comorbidities). The costs were highest for haematological cancers (1.45, 95% CI: 1.38–1.52, p < 0.005) and those living in the London region (1.10, 95% CI: 1.02–1.19, p < 0.005). Conclusions: Healthcare in the last year of life for advanced cancer patients is costly and offers unclear value to patients and the healthcare system. Further research is needed to understand distinct cancer populations{\textquoteright} pathways and experiences before recommendations can be made about the most appropriate models of care.",

keywords = "Humans, Infant, Newborn, Information Storage and Retrieval, Neoplasms/therapy, Palliative Care, Retrospective Studies, Terminal Care",

author = "Xhyljeta Luta and Katharina Diernberger and Joanna Bowden and Joanne Droney and Hall, {Peter S} and Joachim Marti",

note = "Funding Information: We would like to thank members of the advisory board Julia Riley, Sandra Campbell Catherine Urch, Bee Wee, Harry Quilter-Pinner, Ivor Williams and Gianluca Fontana for their valuable feedback and CPRD for providing the data used in the study. Funding Information: This work was supported by the Health Foundation ( www.health.org.uk ). The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript. Open access funding provided by University of Lausanne. Publisher Copyright: {\textcopyright} 2022, The Author(s).",

year = "2022",

month = sep,

day = "1",

doi = "10.1038/s41416-022-01828-0",

language = "English",

volume = "127",

pages = "712--719",

journal = "British Journal of Cancer",

issn = "0007-0920",

publisher = "Nature Publishing Group",

number = "4",

}

TY - JOUR

T1 - Intensity of care in cancer patients in the last year of life: a retrospective data linkage study

AU - Luta, Xhyljeta

AU - Diernberger, Katharina

AU - Bowden, Joanna

AU - Droney, Joanne

AU - Hall, Peter S

AU - Marti, Joachim

N1 - Funding Information: We would like to thank members of the advisory board Julia Riley, Sandra Campbell Catherine Urch, Bee Wee, Harry Quilter-Pinner, Ivor Williams and Gianluca Fontana for their valuable feedback and CPRD for providing the data used in the study. Funding Information: This work was supported by the Health Foundation ( www.health.org.uk ). The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript. Open access funding provided by University of Lausanne. Publisher Copyright: © 2022, The Author(s).

PY - 2022/9/1

Y1 - 2022/9/1

N2 - Background: Delivering high-quality palliative and end-of-life care for cancer patients poses major challenges for health services. We examine the intensity of cancer care in England in the last year of life. Methods: We included cancer decedents aged 65+ who died between January 1, 2010 and December 31, 2017. We analysed healthcare utilisation and costs in the last 12 months of life including hospital-based activities and primary care. Results: Healthcare utilisation and costs increased sharply in the last month of life. Hospital costs were the largest cost elements and decreased with age (0.78, 95% CI: 0.73–0.72, p < 0.005 for age group 90+ compared to age 65–69 and increased substantially with comorbidity burden (2.2, 95% CI: 2.09–2.26, p < 0.005 for those with 7+ comorbidities compared to those with 1–3 comorbidities). The costs were highest for haematological cancers (1.45, 95% CI: 1.38–1.52, p < 0.005) and those living in the London region (1.10, 95% CI: 1.02–1.19, p < 0.005). Conclusions: Healthcare in the last year of life for advanced cancer patients is costly and offers unclear value to patients and the healthcare system. Further research is needed to understand distinct cancer populations’ pathways and experiences before recommendations can be made about the most appropriate models of care.

AB - Background: Delivering high-quality palliative and end-of-life care for cancer patients poses major challenges for health services. We examine the intensity of cancer care in England in the last year of life. Methods: We included cancer decedents aged 65+ who died between January 1, 2010 and December 31, 2017. We analysed healthcare utilisation and costs in the last 12 months of life including hospital-based activities and primary care. Results: Healthcare utilisation and costs increased sharply in the last month of life. Hospital costs were the largest cost elements and decreased with age (0.78, 95% CI: 0.73–0.72, p < 0.005 for age group 90+ compared to age 65–69 and increased substantially with comorbidity burden (2.2, 95% CI: 2.09–2.26, p < 0.005 for those with 7+ comorbidities compared to those with 1–3 comorbidities). The costs were highest for haematological cancers (1.45, 95% CI: 1.38–1.52, p < 0.005) and those living in the London region (1.10, 95% CI: 1.02–1.19, p < 0.005). Conclusions: Healthcare in the last year of life for advanced cancer patients is costly and offers unclear value to patients and the healthcare system. Further research is needed to understand distinct cancer populations’ pathways and experiences before recommendations can be made about the most appropriate models of care.

KW - Humans

KW - Infant, Newborn

KW - Information Storage and Retrieval

KW - Neoplasms/therapy

KW - Palliative Care

KW - Retrospective Studies

KW - Terminal Care

U2 - 10.1038/s41416-022-01828-0

DO - 10.1038/s41416-022-01828-0

M3 - Article

C2 - 35545681

SN - 0007-0920

VL - 127

SP - 712

EP - 719

JO - British Journal of Cancer

JF - British Journal of Cancer

IS - 4

ER -

Intensity of care in cancer patients in the last year of life: a retrospective data linkage study

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Keywords / Materials (for Non-textual outputs)

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