1. How is place of death for cancer patients changing and what affects it? UKACR Conference September 28 th 2004 Elizabeth Davies Karen Linklater Ruth Jack Laura Clark Henrik Møller

2. Why study place of death? Symptom control and place of death matter to patients and their relatives Research reviews find 50-70% of seriously ill patients would prefer to be cared for at home 30-year growth of the hospice and palliative care movement with public support

3. Is this important for policy and planning? United Kingdom 2003 NICE Supportive and Palliative Care for Adults with Cancer 2004 House of Commons Health Committee Palliative Care Europe 2004 WHO – Palliative Care – The Solid Facts 2004 WHO Better Palliative Care for Older People USA 2004 Forthcoming National Institutes of Health State of the Science on improving end of life care

4. Percentage of home cancer deaths in English regions 1985-1994 (all ages) Higginson et al, Palliative Medicine 1998;12:353-363

5. Objectives To describe trends for place of death for four most common cancers between 1985 and 2002 in our area To test associations with case mix variables: age sex cancer site (lung, breast, colorectal and prostate) basis of diagnosis (clinical or microscopic) To explore association with income deprivation

6. Methods Analysis of 216,404 cases Residents diagnosed and dying between 1985 and 2002 In our area Not notified by death certificate only Recorded as dying from their cancer Outcome Death in acute hospitals, at home, in hospices or nursing homes Modelled logistic regression, adjusted for case mix variables

7. Trends for place of death in south east England 1985-2002

8. Age of patient and place of death from cancer in SE England 1985-2002

9. Income deprivation and place of death in SE England 1985-2002

10. Implications Cancer patients remain more likely to die in hospital Recent decline in home death needs investigation Does death in a nursing home count as “home death”? By what mechanism does deprivation affect hospital and home death? Next steps Develop models exploring disease stage at diagnosis and length of survival Relate to palliative care service availability over time in network areas