Place of death in children and young people with cancer and implications for end of life care: a population-based study in England, 1993–2014

BMC Cancer

Research Article

Irene J. Higginson¹  Wei Gao¹  Janet Peacock²  Anne Greenough³  Claudia Wells⁴  Charles Stiller⁵  Julia Verne⁶ 

[1] King’s College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, Bessemer Road, Denmark Hill, SE5 9PJ, London, UK;King’s College London, Division of Health and Social Care Research, Addison House, Guy’s Campus, SE1 1UL, London, UK;King’s College London, School of Medicine, Division of Asthma, Allergy and Lung Biology, Denmark Hill, SE5 9RS, London, UK;Office for National Statistics, Life Events and Population Sources Division, Cardiff Road, NP10 8XG, Newport, Wales, UK;Public Health England, Childhood Cancer, 4150 Chancellor Court, Oxford Business Park South, OX4 2GX, Oxford, UK;Public Health England, Knowledge & Intelligence Team (South West), Grosvenor House, 149 Whiteladies Road, BS8 2RA, Bristol, UK;

关键词: End of life care;    Children and young people;    Place of death;    Cancer;    Palliative care;    Inequality;   

DOI  :  10.1186/s12885-016-2695-1

 received in 2016-04-03, accepted in 2016-08-07,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundEfforts to improve end of life care (EoLC) have made tangible impacts on care in adults, including enabling more people to die at their preferred place of death (PoD), usually home or hospices. Little is known how the PoD in children and young people (CYP, ≤24 years) has changed over time, especially in the context of a series of national initiatives for EoLC improvement since the late 1990s. To inform evidence-based policy-making and service development, we evaluated the national trends of PoD and the associated factors in CYP who died with cancer.MethodsPopulation-based observational study in the National Health Service (NHS) England, 1993-2014. All non-accidental CYP deaths with cancer (N = 12,774) were extracted from the death registration database of the Office for National Statistics (ONS).ResultsHospital deaths reduced from >50 to 45 %, hospice deaths were rare but more than doubled from 6 % in 1993–2000 to 13 % in 2005–2014, and home deaths fluctuated at around 40 %. Those aged 0–19 years were more likely to die at home than young adults (adjusted proportion ratio (PRs): 1.23–1.62); haematological cancer patients or those with 2+ comorbid conditions had higher chances of hospital death (PRs for home: 0.18–0.75, hospice: 0.04–0.37); deprivation was associated with a reduced chance of home death (PRs: 0.76–0.84). The residential region affected hospice but not home deaths. The variations of PoD by cause of death, comorbid conditions and deprivation slightly decreased with time.ConclusionsHospitals and home were the main EoLC settings for CYP with cancer. Home death rates barely changed in the past two decades; deaths in hospitals remained the most common but slightly shifted towards hospices. CYP with haematological malignancy or with comorbid conditions had persistently high hospital deaths; these cases had an even lower chance of deaths in hospices (50 %) than at home. There were deprivation- and area-related inequalities in PoD which may need service- and/or policy-level intervention. The findings highlight a need for CYP specific initiatives to enhance EoLC support and capacities both at home and in hospices.

【 授权许可】

CC BY   
© The Author(s). 2016