7 December 2017
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[i]. New analysis reveals that they had over 2 million emergency visits to hospital towards the end of their lives – over 250,000 each year[ii]. 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[iii] 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[iv], 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[v]
- 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.[vi]
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
For further information, please contact:
Patrick Pringle, Senior Media & PR Officer, Macmillan Cancer Support
0207 840 4891 (out of hours 07801 307068)
Notes to Editors:
About Macmillan Cancer Support
There are 2.5 million people living with cancer in the UK. One in two people are likely to get cancer in their lifetimes. Cancer can affect everything, including a person’s body, relationships and finances.
Macmillan Cancer Support provides practical, emotional and personal support to people affected by cancer every year. The charity is there to support people during treatment, help with work and money worries, and listen when people need to talk about their feelings.
Macmillan receives no government funding and relies on generous donations from the public. People up and down the country show their support for Macmillan – from hosting or attending a World’s Biggest Coffee Morning to running a marathon or giving up alcohol – so the charity can help more and more people affected by cancer every year.
Life with cancer is still your life and Macmillan is there to help you live it. If you want information or just to chat, call 0808 808 00 00 (Monday to Friday, 9am–8pm) or visit www.macmillan.org.uk.
[i] National Cancer Registration and Analysis Service, Public Health England and Macmillan Cancer Support. 2017. Macmillan-NCRAS End of Life Emergency Visits Workbook.
www.ncin.org.uk/about_ncin/releases. Analysis of routinely collected NHS data on 533,410 people in England who died from cancer between 1st Jan 2011 – 31st Dec 2015 within 10 years of being diagnosed.
[ii] The analysis looks at the number of emergency visits that these people experienced after cancer diagnosis in up to the last three years of their life. The statistics include all emergency visits, including visits to A&E that don’t result in admission, and admissions to hospital that come through emergency route to admission such as A&E or urgent referral from another hospital. It includes all emergency visits and not just those which are cancer related – although as people are in the last three years of life and go on to die due to cancer many of these visits are likely to be directly or indirectly related to their terminal cancer.
[iii] Choice in end of life care: government response 2016https://www.gov.uk/government/publications/choice-in-end-of-life-care-government-response
[iv] National Cancer Registration and Analysis Service, Macmillan Cancer Support and Public Health England. 2017. Cancer deaths by deprivation, place of death, and emergency admission in last year of life. Analysis of all cancer deaths in 2015. The most deprived areas refer to the quintile with the highest deprivation based on the income domain of the index of multiple deprivations 2015. The least deprived refers to the quintile with the lowest deprivation.
[v] Yougov Plc. (2017). Macmillan commissioned YouGov Plc. to survey UK adults with a cancer diagnosis. Total sample size was 2005 people with a previous cancer diagnosis, and 1878 people answered our questions relating to death and dying. Fieldwork was undertaken between 20th - 29th March 2017.
Respondents were asked: “If the right care and support was available in any of these locations, where would you prefer to spend your final days?” Just 1% of social grade ABC1 and 2% of C2DE respondents answered that they would prefer to die in a hospital.
[vi] Walsh, B. and Laudicella, M. (2017). Disparities In Cancer Care And Costs At The End Of Life: Evidence From England's National Health Service. Health affairs (Project Hope), 36(7), pp. 1218–1226. doi:10.1377/hlthaff.2017.0167.