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USE OF HOSPITAL SERVICES AMONG PALLIATIVE OESOPHAGO-GASTRIC CANCER PATIENTS
  1. O Groene1,2,
  2. A Taylor1 and
  3. D Cromwell1,2
  1. 1The Royal College of Surgeons of England, UK
  2. 2London School of Hygiene and Tropical Medicine, UK

    Abstract

    Introduction A high proportion of patients on a palliative care pathway continue to use hospital services or die in hospital, despite calls for increased care in the community. Further research is required to distinguish hospitalisation near end of life for specific disease pathways, since a wide range of factors influence service utilisation and place of death. For oesophago-gastric cancer patients with palliative treatment intent, three treatment options exist: palliative oncological treatment, endoscopic treatment, and best supportive care.

    Aim(s) and method(s) This study sought to assess health service utilisation of patients diagnosed with oesophago-gastric cancer on a palliative care pathway. Patient data were obtained from the National Oesophago-gastric Cancer Audit and linked to the Hospital Episode Statistics (HES) dataset. For each patient, the method of hospital admission, date and mode of treatment intent was identified.

    Results 8,499 palliative care patients were identified in the linked audit-HES dataset. 4,036 patients had an oncology treatment plan, 1,526 had endoscopic care, and 2,887 had best supportive care. 85.6% who received oncological care were re-admitted to hospital one or more times, in comparison to 76.3% and 50.7% who received endoscopic care and best supportive care respectively (p<0.001). Multivariate analysis suggests a six fold risk (OR 6.2; CI 95% 4.6–8.6) of hospital admissions for patients receiving oncological care, as compared to best supportive care. More than half (50.2%) of patients receiving palliative oncology experienced 4 or more emergency admissions before death.

    Conclusion(s) This study suggests that palliative treatment decisions must be carefully made with hospital re-admission risk in mind.

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