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Poorest cancer patients let down at end of life, says new report

Macmillan’s new research into cancer patients’ final months and years reveals:

  • People dying from cancer face hundreds of thousands of emergency hospital visits every year
  • Poorest cancer patients have more emergency visits towards the end of their life and are more likely to die in hospital
  • The charity is calling on national and regional health leaders to end inequality and make sure everyone receives the right care at the end of life
  • Macmillan warns that being in A&E at the end of life can be extremely distressing, and says preventing unnecessary emergency visits would help relieve pressure on already over-stretched emergency services

Research into more than half a million cancer patients in England, carried out by Macmillan Cancer Support using data analysis from Public Health England, has painted a vivid picture of the experiences of people dying of cancer. The research shows that cancer patients approaching the end of their life face repeat emergency visits, and – according to worrying analysis revealed in a new report today – the situation is even worse for the poorest people.

Huge number of emergency visits

Between 2011 and 2015, 533,000 people in England died of cancer within ten years of being diagnosed with the disease. New analysis reveals that they had over 2 million emergency visits to hospital towards the end of their lives – over 250,000 each year. Each year, around 57,000 people die within a year of being diagnosed with cancer – and they have over 85,000 emergency visits in the short time between being diagnosed and dying.

The charity says more rapid progress must be made towards delivering the government’s national commitment to improve end of life care and ensure everyone’s choices on where they spend their last weeks and days are respected.

‘Even worse’ for the poor

In The Final Injustice, published today, Macmillan Cancer Support warns that the experiences of the most deprived people with advanced cancer are even worse.

The report includes further data analysis from Public Health England on 130,700 people in England who died from cancer in 2015, which found that:

  • Cancer patients from the most deprived areas were 18% more likely to die in hospital than those from the least deprived areas. This is despite previous Macmillan research finding that most people with cancer, across all socio-economic backgrounds, prefer to die at home or in a hospice.
  • Cancer patients from the most deprived areas had in total around 15,000, or 15%, more emergency hospital admissions in the final year of life than those from the least deprived areas.

Macmillan says that the findings demonstrate an ‘unacceptable gulf’ between the experiences of cancer patients in England, with factors such as deprivation affecting whether a person receives the right care and choice when they die.  The charity calls on the Government and regional health leaders to end this variation and make sure everyone has access to the right care and support when they die.

Macmillan believes that ensuring people with advanced cancer have access to the support they need in the community, as well as the opportunity to plan ahead for the end of their lives, could help avoid distressing emergency admissions and allow people more choice around their care. Preventing unnecessary trips to A&E would also help relieve pressure on already over-stretched emergency services. Previous research funded by Macmillan and City, University of London and the Economic and Social Research Institute estimated that extra hospital care for deprived cancer patients, for the four most common cancers alone, cost the NHS an extra £4.6 million a year.

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

“Access to the right care and support when you die should be a universal right, and not depend who you are or where you are from. Our new report shows that this is far from the case, and vulnerable people in the poorest parts of England are facing a higher number of emergency admissions and are more likely to die in hospital – which can be upsetting and stressful for that person, not to mention their friends and family.

“There is also a huge amount of pressure on acute care and A&E, which is set to worsen as we enter the winter months. With the right community support in place, we believe many cancer patients can avoid unnecessary and distressing emergency visits, which can reduce some of the pressure on the overstretched A&E services.

“Ultimately, this variation is a sign of a system that is failing those who need it most. That’s why the Government needs to provide strong leadership in improving care for dying people, and make sure local services have the resources to deliver the care people need – regardless of where they are from.”

Charity Bagwell, 30, from Surrey, whose mother Valerie, 65, died in December 2014 from pancreatic cancer.

She said: “In December my mum’s condition rapidly deteriorated and she was rushed to A&E in severe pain. She was passed from doctor to doctor without pain relief. We had been promised by the hospital’s support worker that they’d co-ordinate care between them and the hospice but the promises came to nothing.

“In the end she was moved out of A&E to a kind of stop-gap ward and was still in terrible pain. She died the next day but she didn’t look peaceful – she had a horrible expression on her face and I knew she was in pain.”

The Final Injustice can be viewed here: www.macmillan.org.uk/the-final-injustice

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