April 30, 2013—The number of cancer patients who die in acute care hospitals varies across Canada. About two in three cancer patients in Manitoba (69%) and New Brunswick (66%) die in hospital, compared with two in five in Ontario (40%) and British Columbia (39%), according to a new study released by the Canadian Institute for Health Information (CIHI).
CIHI’s study, End-of-Life Hospital Care for Cancer Patients, examines the use of hospital services by cancer patients who died in acute care hospitals across Canada (excluding Quebec). More than 25,000 people died in hospital from cancer in 2011–2012, representing 45% of all estimated cancer deaths that year.
Differences in the availability of palliative care beds in some provinces, and the location of such beds in others, may be contributing to the variations in in-hospital deaths.
“Surveys have shown that most people—cancer patients included—do not want to die in a hospital. However, almost half of Canadian cancer patients are dying there,” says Kathleen Morris, Director of Health System Analysis and Emerging Issues at CIHI. “This could be related to many factors, such as the availability of home care or hospice services. Provincial variations point to areas of needed improvement across the country.”
The study found that about one in five (22%) patients was admitted to hospital with a sole diagnosis of palliative care. It is possible that some of these patients could have benefited from receiving their end-of-life care somewhere other than a hospital. For example, more than one-third (34%) of patients with a most responsible diagnosis of palliative care had stays longer than two weeks. This could have been enough time to arrange for care in an alternate setting—if this was the preference of these patients and if it was available.
Little evidence of potentially over-aggressive treatment during final days
The majority (84%) of the patients in CIHI’s study died in a hospital with an intensive care unit (ICU). However, only 11% were admitted to the ICU in their final two weeks of life, and only 8% died there.
Additionally, very few (3%) patients received inpatient chemotherapy treatment—typically considered a life-saving treatment—within their final 14 days.
CIHI also found that more than four in five (82%) patients had a documented palliative care diagnosis during their last admission. Palliative care was the main reason for hospitalization for more than half (53%) of all patients in the study. However, it is not known what specific palliative care services were received or how many people may have had access to alternative palliative settings, such as hospice or home care.
“With two out of five Canadians expected to develop cancer in their lifetime and one out of four Canadians estimated to die from the disease, there is an increasing need for high-quality palliative and end-of-life care services,” says Lee Fairclough, Vice-President, Strategy, Knowledge Management and Delivery, at the Canadian Partnership Against Cancer. “This report provides data to help inform changes in this area, and we’re working with partners to support patients, caregivers and families in making important choices on where care is provided and to improve the palliative and end-of-life care journey for Canadians.”
Patients from rural areas have higher chances of multiple admissions before death
Cancer patients from rural areas were more likely to have multiple hospital admissions in their last four weeks of life than their urban counterparts. Almost one in three (30%) rural patients had two or more admissions, compared with one in five (20%) urban patients,
“Multiple hospital visits for cancer patients nearing the end of their lives can be difficult for both the individual and their caregivers, and they may indicate challenges with access to community-based services,” says Jeremy Veillard, CIHI’s Vice President of Research and Analysis. “Well-coordinated care can reduce frequent and possibly unnecessary admissions and can help ensure there is no disruption in the continuity of care the patient receives.”
CIHI found that, across the provinces, the proportion of patients admitted to hospital multiple times in the last 28 days of life was highest in Saskatchewan (31%) and Newfoundland and Labrador (28%) and lowest in Nova Scotia (21%), Prince Edward Island (21%) and Manitoba (19%).
Provincial Variations in the Proportion of Cancer Patients Who Died in Acute Care Hospitals as a Percentage of Total Projected Cancer Deaths, 2011–2012 (Figure 1 in the report)
Frequency of Acute Care Admissions by Cancer Patients in Last 28 Days of Life (Figure 3 in the report)
Provincial Variations in the Percentage of Patients Admitted to ICU in Last 14 Days of Life (Figure 7 in the report)