In Northern Ireland, late cancer diagnosis is a major contributor to hospital deaths, in spite of the fact that most patients would prefer to spend their last days at home, researchers from Queen’s University Belfast found. This study, carried out by the Northern Ireland Cancer Registry and funded by the Ulster Cancer Foundation, found that not only are cancer patients who die in hospital extremely ill, but also that late diagnosis was the main cause of their advanced illness and subsequent hospital death.

The authors add that theirs is the first Northern Ireland study to focus on why patients with cancer die in acute hospitals.

Although most cancer patients prefer to die at home, only a third of them do. 12.5% die in hospices while 8% do so in care homes or nursing/residential homes.

The report, titled “Why Cancer Patients Die in Acute Hospitals” gathered data from the hospital records of 695 cancer patients who had died in hospital during the second half of 2007. The investigators checked period length between cancer diagnosis and death, as well as where the patients preferred to die, and compared it to where they actually died.

They found that:

  • More than one quarter of all premature Northern Ireland deaths are cancer related, a total of 4,150 annual deaths.
  • The average cancer patient who died in hospital did so at 74 years of age.
  • The average length of time from diagnosis to death was 4 months. One third of patients died within four weeks of being diagnosed. The authors stress that late diagnosis is a problem of concern
  • Most late diagnoses involved lung and digestive organs cancers. Older and non-partnered patients with cancer are more likely to be diagnosed late
  • Nearly 40% of those who died in hospital had requested specifically to return home. Three-quarters of them could not return home because their condition had deteriorated so much.
  • 12.4% of them did not have a suitable bed, while 4.9% did not have the necessary care package in place. 3% of them did not have the required family support
  • Between 1983 and 1992, 38.1% of patients cancer patients died at home, compared to 32.1% between 2003 and 2007. However, a greater number today die in nursing homes, which should probably be classed as the patient’s home.
  • Male cancer patients, as well as those with partners, younger individuals and people from deprived backgrounds were more likely to die at home

The authors recommend that a major initiative be undertaken to improve prompt identification of cancer signs and symptoms among health care professionals and lay individuals. Nursing home staff should receive specialized training in recognizing cancer symptoms early on – they should also have clearly laid out strategies to help residents with cancer die where they wish.

The researchers add that those who do manage to die in their place of preference should do this with proper facilities and resources.

More research should be carried out to determine exactly what kind of support works best for those who choose to die at home.

In a communiqué, the researchers wrote:

“The report highlights the importance of the recommendations made within the 2010 Palliative and End of Life Care Strategy for Northern Ireland (DHSSPS, 2010) and recommends that these should be included in training and in appropriate protocols for professionals who work with cancer patients.”

Dr Anna Gavin, Director of the Northern Ireland Cancer Registry, explained:

“The findings of this study are significant as they identify the good work that is ongoing in palliative care but also highlights areas in need of improvement. The report highlights a need to address the problem of late diagnosis of cancer. N. Ireland is one of 12 areas working in a major international benchmarking project to determine reasons for late cancer diagnosis with the aim of improving survival to this end and a population survey on cancer awareness is due to take place here in May/June.”

Roisin Foster, Chief Executive of the Ulster Cancer Foundation said:

“The Ulster Cancer Foundation is very pleased to have been able to fund this research by the NI Cancer Registry. Its findings have the potential to promote earlier diagnosis of cancer among older people. It also points to improvements in community services that would enable more people have their final wish to die at home honoured. This research was funded by donations from the Northern Ireland public. Our supporters can be assured that their generosity is making a real difference now and in the future”

Source: Queen’s University Belfast

Written by Christian Nordqvist