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Significant Reduction in Deaths in Hospital Over a Decade in an Increasingly Elderly Population Dying From Pelvic Cancer in England: A Population Based Study

Beena A, Pring A, Georgeson B, Sheppard S, Gornall R, Hounsome L and Verne J

Background: In England more than 70% of people prefer to die at home. 29% of all deaths have an underlying cause of cancer during 2004-2013. Pelvic cancer (Gynaecological, urological and colorectal) accounts for 18.6% of all cancer deaths. This group of patients have overlapping speciality care needs and similar complications which could lead to multiple hospital admissions and hence many die in hospital. Many people do not receive care which meets their individual needs including where they prefer to die.

Aim: To find out where patients with pelvic cancer die as a 'proxy' for quality of care, the variations by geography and demographics and whether this has changed since the publication of the National End of Life Care Strategy in 2008.

Design: A national population based study to investigate factors influencing place of death with an underlying cause of death of pelvic cancer.

Results: The proportion of pelvic cancers deaths (underlying cause) that occur in hospital declined from 46% in 2004 to 34% in 2013 (p<0.001); deaths occurring at home/care home increased from 33% in 2004 to 46% in 2013 (p<0.001). Three quarters (73%) were aged 70 years or over. 71% of the care home residents, died in a care home but only 36% of those who lived at home died at home (p<0.001). Multivariate regression analysis show age and deprivation quintile are the significant (P<0.001) factors.

Conclusion: There has been a highly significant reduction in the proportion of pelvic cancer deaths in hospital in England consistent with aims of the End of Life Care Strategy. Older people, the most deprived and people living in their own home are more likely to die in hospital.