Calls for terminally-ill to have greater choice of where to die

Charities yesterday called for greater choice for terminally ill patients after the first Scottish Government report of its kind revealed more than half of all cancer patients die in hospital.

The inaugural Place of Death report found half of the 75,000 deaths from cancer in Scotland between 2003-2007 were in NHS acute hospitals and only around a quarter of deaths were at home.

The report found that it was likely that lack of facilities for caring for people at home who suffer difficulties or related complications in their dying days mean people are ending their lives in hospital when they’d rather be at home.

But social reasons, such as the need to provide respite to a carer, were also cited.

The report also found 17% of cancer deaths were in hospices, and the remainder died in other institutions such as care homes and private hospitals.

The study will be used to help the Scottish Government’s Living and Dying Well Action Plan for formulating care for patients with life-limiting conditions.

The study provides a benchmark for the Scottish Government to now act swiftly in providing greater choice by charities such as Marie Curie Cancer Care.

Its own research shows that nearly 70% of people would want to be cared for at home if they were dying.

It believes it would cost less to care for people at home if it was properly organised, saying its models show for every £1 spent on caring for someone at home, £2 is freed up in NHS hospitals.

David Oxenham, medical director of Palliative Care at Marie Curie Hospice, Edinburgh, said: “More than 50% of cancer deaths still occur in hospital in Scotland, the place people say they would least like to be.

“We hope that this report will better inform the services required in each NHS Health Board and that more people will be able to choose the place of death that they wish.”

The charity cited its delivering choice programme in Tayside, one of seven UK schemes and the only one in Scotland, as a good example of providing choice to patients.

By involving the NHS, social services, the voluntary and independent sectors it has managed to increase the percentage of those dying at home from 17% to 42%.

Elspeth Atkinson, Macmillan Cancer Support’s director for Scotland, said broader agreement on care is needed. She said: “As most end-of-life treatment and care is delivered across local health, social care and voluntary sector services, co-ordination of the multi-disciplinary teams involved is essential.

“Models of good practice do exist in supporting the patients’ choice to die at home and it is our belief that all cancer patients should receive high-quality palliative and end-of-life care no matter where they are cared for.”

The report found people from deprived areas appeared to be slightly more likely to die at home and over the last 10 years the trend on where people died has remained relatively unchanged.

Jo Cartwright, of campaigners Dignity in Dying, said: “We already know there are access inequalities to good quality end-of-life care, based on geography and diagnosis. The report highlights that there may also be inequality based on financial status.

“This clearly shouldn’t be the case, and further research is urgently required to identify why these barriers exist so that effective action can be taken to ensure that everybody has access to good quality end-of-life care, based entirely on need, and no other factor.”

Last year Health Minister Nicola Sturgeon said terminally ill patients will be given the right to die at home under the first comprehensive plan being developed for end-of-life care in Scotland, with round-the-clock community support so people do not have to spend their final days in hospital against their wishes.

A Scottish Government spokesman said the action plan provided the basis for a single, comprehensive approach to palliative care and end of life that will be “embedded” across the country.

Cancer facts

Skin
The number of cases has gone up by 50% among men within a decade, with increased exposure to sunlight a key factor in the rise. The 50% rise in men over this period resulted in 445 cases in 2006, making it the eighth most common cancer.

The illness is the fourth most common cancer for women, with 543 cases in 2006 – a rise of 30% over the previous decade.

Breast
The number of women with breast cancer is also continuing to increase, being the most common cancer among women in 2006 with 4079 cases. The rate rose by 10% over the previous decade.

The rise is partly down to increased detection by the Scottish Breast Screening programme, which has seen a rise in attendance between 1996 and 2006.

Lung
Lung cancer remains the most common cancer in men but is only marginally more common than prostate cancer.

In 2006 there were 2509 cases of male lung cancer, down 22% on the previous 10 years.

But the number of women with lung cancer has gone up by 5% over the decade, reflecting differing trends in smoking between men and women.

Lung cancer was the most common overall in 2006.

Prostate
There were 2506 cases of prostate cancer in 2006, and the number of men with prostate cancer between 1996 and 2006 rose by 14%.

Statisticians say this is at least partly due to increased detection through the prostate specific antigen test and not necessarily due to increased risk of developing the illness.

Colorectal The third most common cancer in both males and females, but rates have fallen in both sexes by approximately 10% over the past 10 years.

Other cancers
Head and neck, 1065 deaths, down 6% over 10 years; Non- Hodgkin’s, 877 deaths, a rise of 2.3%; Oesophagus, 828 deaths, down 2.3%; Stomach 779, down 28.7%; Bladder, 700, down 49% over 10 years.

Overall About 13,100 males and 13,800 females were diagnosed with cancer – excluding non-melanoma skin cancer – in 2006.