Hospital-based care in the last year of life for people dying from cancer in New South Wales: a retrospective cohort study — ASN Events
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Hospital-based care in the last year of life for people dying from cancer in New South Wales: a retrospective cohort study (#65)

David Goldsbury 1 , Jane M Ingham 2 , Afaf Girgis 3 , Anne Wilkinson 4 , Jane Phillips 2 5 , Patricia Davidson 6 7 , Dianne L O'Connell 1
  1. Cancer Council NSW, Woolloomooloo, NSW, Australia
  2. The University of New South Wales Cunningham Centre for Palliative Care, Sydney, NSW, Australia
  3. Psycho-oncology Research Group, Ingham Institute for Applied Medical Research, The University of New South Wales, Sydney, NSW, Australia
  4. School of Nursing and Midwifery, Edith Cowan University, Perth, WA, Australia
  5. School of Nursing, The University of Notre Dame, Sydney, NSW, Australia
  6. Johns Hopkins University, Baltimore, Maryland, USA
  7. Centre for Cardiovascular and Chronic Care, University of Technology Sydney, Sydney, NSW, Australia

Aim
This study described patterns of acute hospital-based health services utilisation during the last year of life for all adults who died from cancer in a calendar year in New South Wales (NSW).

Methods
Linked, routinely collected administrative data (death records, hospital admissions, emergency department (ED) presentations and cancer registrations) were analysed for all adults who died from cancer in 2007 in NSW. Measures included hospital time, ED presentations, intensive care (ICU) admissions, inpatient palliative care received and place of death.

Results
There were 13,441 adults (median age 75 years) who died from cancer. Among these, 96% had a hospital admission in their final year, with a median of 30 days spent in hospital per decedent in that year (interquartile range 15-53). Hospitalisations were more common for people who died from certain cancer types (e.g. leukaemia, non-Hodgkin lymphoma) and less common for very elderly decedents. Time was spent in an ICU by 11%, including 4% during the last month of life. Clear involvement of an inpatient palliative care service was evident for 39%, although reference to hospital-based palliative care was recorded for 58%. Death occurred in an inpatient facility for 73%, with only 14% of these in clearly identified hospices. In metropolitan areas, 84% presented to an ED at least once in the year, with 14% from the least disadvantaged and 26% from most disadvantaged areas presenting >3 times.

Conclusions
Using linked health records we have described the use of hospital-based health services during the last year of life for all people who died from cancer in NSW. We have also identified gaps in the available administrative data particularly in relation to palliative care service use. Our findings help provide a necessary foundation for planning health services and optimal data collection for cancer patients nearing the end of life.

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