It is already known from recent research that hospital based end of life care of cancer patients is particularly resource intense with a steep cost-increase in the final three months of life. But how this breaks down was, until now, not clearly understood.

In a recent population-wide data linkage study using routinely collected administrative data on hospital based healthcare for cancer patients, led by Katharina Diernberger of the University of Edinburgh, a clearer picture has emerged of the hospital resources used, when they are used, and the associated costs for patients with cancer in their final year of life. The findings of the study show overall that people in Scotland in their last year of life with cancer are high users of secondary care, and that hospitalisation accounts for a high proportion of costs, particularly in the last three month of life. When teased apart, the study revealed some interesting facts:

  • There were differences in age at death across different cancer types with breast and prostate cancer patients living the longest.
  • The patient group suffering from the highest number of additional diseases were ovary and breast cancer patients.
  • The lowest socioeconomic status was reported for lung cancer patients, and hematologic cancers were considerably more resource intense than all solid tumours.
  • Older patients and women used less health care resources in their last year of life.

Generally, the main difference in resource use and costs is due to the type of cancer, because different cancers require different levels of care intensity, as well as closeness to death.

Katharina Diernberger, Research Fellow in Health Economics, explained that “mainly the symptoms connected to specific cancer types define whether treatment needs to take place in hospitals or can be received in other care settings. Knowing that most patients at the end of life prefer to stay in their familiar environment, we recommend further research into factors which help enable good quality home based end of life care. We need better insight how community care and social care can be a realistic alternative to hospital- based care at patients’ end of life.”


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Katharina Diernberger, Research Fellow in Health Economics, University of Edinburgh

Diernberger, K., Luta, X. ., Bowden, J., Droney, J., Lemmon, E., Tramonti, G., Shinkins, B., Gray, E. ., Marti, J. and Hall, P. S. (no date) “Variation in hospital cost trajectories at the end of life by age, multimorbidity and cancer type”, International Journal of Population Data Science, 8(1). doi: 10.23889/ijpds.v8i1.1768.