COVID-19, deaths at home and end-of-life cancer care

Anastasia Arabadzhyan; Katja Grašič; Peter Sivey

doi:10.1016/j.ehb.2023.101338

COVID-19, deaths at home and end-of-life cancer care

Anastasia Arabadzhyan, Katja Grašič, Peter Sivey

Centre for Health Economics

Research output: Contribution to journal › Article › peer-review

Abstract

During the COVID-19 pandemic there was a period of high excess deaths from cancer at home as opposed to in hospitals or in care homes. In this paper we aim to explore whether healthcare utilisation trajectories of cancer patients in the final months of life during the COVID-19 pandemic reveal any potential unmet healthcare need. We use English hospital records linked to data on all deaths in and out of hospital which identifies the cause and location of death. Our analysis shows that during the periods of peak COVID-19 caseload, patients dying of cancer experienced up to 42% less hospital treatment in their final month of life compared to historical controls. We find reductions in end-of-life hospital care for cancer patients dying in hospitals, care homes/hospices and at home, however the effect is amplified by the shift to more patients dying at home. Through the first year of the pandemic in England, we estimate the number of inpatient bed-days for end-of-life cancer patients in their final month reduced by approximately 282,282, or 25%. For outpatient appointments in the final month of life we find a reduction in face-to-face appointments and an increase in remote appointments which persists through the pandemic year and is not confined only to the periods of peak COVID-19 caseload. Our results suggest reductions in care provision during the COVID-19 pandemic may have led to unmet need, and future emergency reorganisations of health care systems must ensure consistent care provision for vulnerable groups such as cancer patients.

Original language	English
Article number	101338
Number of pages	13
Journal	Economics and Human Biology
Volume	52
DOIs	https://doi.org/10.1016/j.ehb.2023.101338
Publication status	Published - 9 Jan 2024

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10.1016/j.ehb.2023.101338Licence: CC BY

COVID-19, deaths at home and end-of-life cancer care
© 2023 The Author(s)
Final published version, 721 KBLicence: CC BY

Cite this

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title = "COVID-19, deaths at home and end-of-life cancer care",

abstract = "During the COVID-19 pandemic there was a period of high excess deaths from cancer at home as opposed to in hospitals or in care homes. In this paper we aim to explore whether healthcare utilisation trajectories of cancer patients in the final months of life during the COVID-19 pandemic reveal any potential unmet healthcare need. We use English hospital records linked to data on all deaths in and out of hospital which identifies the cause and location of death. Our analysis shows that during the periods of peak COVID-19 caseload, patients dying of cancer experienced up to 42% less hospital treatment in their final month of life compared to historical controls. We find reductions in end-of-life hospital care for cancer patients dying in hospitals, care homes/hospices and at home, however the effect is amplified by the shift to more patients dying at home. Through the first year of the pandemic in England, we estimate the number of inpatient bed-days for end-of-life cancer patients in their final month reduced by approximately 282,282, or 25%. For outpatient appointments in the final month of life we find a reduction in face-to-face appointments and an increase in remote appointments which persists through the pandemic year and is not confined only to the periods of peak COVID-19 caseload. Our results suggest reductions in care provision during the COVID-19 pandemic may have led to unmet need, and future emergency reorganisations of health care systems must ensure consistent care provision for vulnerable groups such as cancer patients.",

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