Deaths from urological cancers in England 2001-10
Deaths from Urological Cancers in England, 2001-10
Published: 10 October 2012 Data revisions: 29 November 2012 - see page 30 of report for details
Urological cancers include penile, prostate, testicular, kidney, renal pelvis and ureter, and bladder cancers.
The aim of the report is to help end of life care commissioners and providers improve planning and service delivery in line with the needs and wishes of patients.
People dying with a urological cancer have specific end of life care needs. The report highlights variations by cancer type, age, sex, region, place of death and socioeconomic status, which helps us understand those needs better.
The report also includes information on hospital admission costs in the last year of life and how they vary by type of urological cancer.
Extended criteria donors in liver transplantation Part II reviewing the impac...Balázs Nemes
This document reviews the impact of extended-criteria donors on complications and outcomes of liver transplantation. It finds that extended-criteria donors are associated with higher risks of early allograft dysfunction, especially when donors have moderate to severe steatosis. Extended criteria donors also increase the risk of biliary complications and recurrence of hepatitis C virus. However, with new antiviral regimens, sustained virological response can be achieved in most patients. The use of extended criteria donors reduces long-term survival rates, with 1-year survival rates of 87% for low-risk donors and 40% for high-risk donors. Graft survival is excellent for donors up to a certain risk score but declines significantly above that threshold.
This document summarizes several urological cancers including bladder cancer, prostate cancer, renal cancer, and testicular cancer. It covers the epidemiology, risk factors, histopathology, presentation, investigation, staging, treatment, and prognosis for each cancer type. Superficial bladder cancer has a 5-year survival of over 80% with transurethral resection and chemotherapy/immunotherapy, while invasive bladder cancer has a 5-year survival of 25-50% with radical surgery, radiotherapy, or chemotherapy. Prostate cancer is the most common male cancer, and treatment options range from watchful waiting to radical prostatectomy or radiotherapy depending on stage. Renal cancer has a 5-year survival of 80% for
Death from liver disease : Implications for end of life care in England
22 March 2012
This report presents the latest data on place of death for those with liver disease and shows how this varies with sex, age, region, socioeconomic deprivation and place. It is aimed at commissioners and providers of end of life care, clinicians caring for patients with liver disease, and others concerned with providing quality end of life care for this patient group, including patients themselves and their carers.
Some key findings:
Liver disease causes approximately 2% of all deaths
The number of people who die from liver disease in England is rising (from 9,231 in 2001 to 11,575 in 2009)
More men than women die from liver disease (60% are men, 40% women)
Alcoholic liver disease accounts for well over a third (37%) of liver disease deaths.
The document provides a literature review that aims to critically evaluate the effectiveness of biennial faecal occult blood tests versus decennial colonoscopies in reducing colorectal cancer mortality rates in the UK screening program. It conducted an extensive search of academic databases and reviewed 31 peer-reviewed publications from the last 15 years. The review assessed evidence on the rationale, accuracy, reliability, cost-effectiveness, and social and ethical considerations of each screening tool to determine their ability to reduce colorectal cancer deaths in a real-world setting. It aims to evaluate which tool is most effective and justified for the UK screening program based on the evidence.
Deprivation and death: Variation in place and cause of death
08 February 2012 - National End of Life Care Intelligence Network (NEoLCIN)
This report suggests that people who live in deprived areas are more likely to die in hospital than those living in affluent areas.
The report reveals that 61% of deaths amongst people living in the most deprived quintile (the poorest 20% of areas) occurred in hospital - compared to 54% amongst the two least deprived quintiles. It concludes that the gap is not solely accounted for by factors such as differences in the causes of death between the social groups.
This document provides a guide for healthcare facilities to increase colonoscopy screening rates for colorectal cancer prevention. It discusses how colonoscopy is the most effective screening tool, yet rates remain low, especially among minority groups. The goal is to double colonoscopy screening in New York City over 5 years by providing best practices and tools. Section I outlines 5 best practices clinics can adopt, such as promoting routine referrals for those 50+, direct referrals, and reducing no-shows. Section II provides clinician tools on bowel prep, sedation, and follow-up. Section III offers administrative resources like CPT codes, referral forms, and a patient navigation program description.
Extended criteria donors in liver transplantation Part II reviewing the impac...Balázs Nemes
This document reviews the impact of extended-criteria donors on complications and outcomes of liver transplantation. It finds that extended-criteria donors are associated with higher risks of early allograft dysfunction, especially when donors have moderate to severe steatosis. Extended criteria donors also increase the risk of biliary complications and recurrence of hepatitis C virus. However, with new antiviral regimens, sustained virological response can be achieved in most patients. The use of extended criteria donors reduces long-term survival rates, with 1-year survival rates of 87% for low-risk donors and 40% for high-risk donors. Graft survival is excellent for donors up to a certain risk score but declines significantly above that threshold.
This document summarizes several urological cancers including bladder cancer, prostate cancer, renal cancer, and testicular cancer. It covers the epidemiology, risk factors, histopathology, presentation, investigation, staging, treatment, and prognosis for each cancer type. Superficial bladder cancer has a 5-year survival of over 80% with transurethral resection and chemotherapy/immunotherapy, while invasive bladder cancer has a 5-year survival of 25-50% with radical surgery, radiotherapy, or chemotherapy. Prostate cancer is the most common male cancer, and treatment options range from watchful waiting to radical prostatectomy or radiotherapy depending on stage. Renal cancer has a 5-year survival of 80% for
Death from liver disease : Implications for end of life care in England
22 March 2012
This report presents the latest data on place of death for those with liver disease and shows how this varies with sex, age, region, socioeconomic deprivation and place. It is aimed at commissioners and providers of end of life care, clinicians caring for patients with liver disease, and others concerned with providing quality end of life care for this patient group, including patients themselves and their carers.
Some key findings:
Liver disease causes approximately 2% of all deaths
The number of people who die from liver disease in England is rising (from 9,231 in 2001 to 11,575 in 2009)
More men than women die from liver disease (60% are men, 40% women)
Alcoholic liver disease accounts for well over a third (37%) of liver disease deaths.
The document provides a literature review that aims to critically evaluate the effectiveness of biennial faecal occult blood tests versus decennial colonoscopies in reducing colorectal cancer mortality rates in the UK screening program. It conducted an extensive search of academic databases and reviewed 31 peer-reviewed publications from the last 15 years. The review assessed evidence on the rationale, accuracy, reliability, cost-effectiveness, and social and ethical considerations of each screening tool to determine their ability to reduce colorectal cancer deaths in a real-world setting. It aims to evaluate which tool is most effective and justified for the UK screening program based on the evidence.
Deprivation and death: Variation in place and cause of death
08 February 2012 - National End of Life Care Intelligence Network (NEoLCIN)
This report suggests that people who live in deprived areas are more likely to die in hospital than those living in affluent areas.
The report reveals that 61% of deaths amongst people living in the most deprived quintile (the poorest 20% of areas) occurred in hospital - compared to 54% amongst the two least deprived quintiles. It concludes that the gap is not solely accounted for by factors such as differences in the causes of death between the social groups.
This document provides a guide for healthcare facilities to increase colonoscopy screening rates for colorectal cancer prevention. It discusses how colonoscopy is the most effective screening tool, yet rates remain low, especially among minority groups. The goal is to double colonoscopy screening in New York City over 5 years by providing best practices and tools. Section I outlines 5 best practices clinics can adopt, such as promoting routine referrals for those 50+, direct referrals, and reducing no-shows. Section II provides clinician tools on bowel prep, sedation, and follow-up. Section III offers administrative resources like CPT codes, referral forms, and a patient navigation program description.
This document provides information about an oncology certification program called "abc in oncology". It discusses the program's aim to provide oncology knowledge to non-oncologists across various medical specialties. The program consists of several modules covering general cancer topics and specific cancer types. It is held every 3-4 weeks for a duration of 12 months, with evaluations to assess participation and knowledge. The document also includes an agenda and details for upcoming modules on colon cancer and breast cancer.
This document discusses inclusion health and digital health. It provides an introduction and agenda for the meeting which will address equality, health inequalities, and digital inclusion. It summarizes research showing health inequalities are associated with increased costs to the health system and wider society. The document also outlines proposed analyses on health inequalities for CCGs to help impact national indicators.
DR ARYA LUNG CANCER SCREENING 28 TH JAN.pptxdranimesharya
This document summarizes guidelines for managing lung nodules found on CT scans from the British Thoracic Society and Fleischner Society. It discusses key points like who should be screened, thresholds for follow up of solid and subsolid nodules based on size, the definition of nodule growth, and duration of follow up for stable nodules. It also notes that lung cancer prevalence is similar for nodules found on screening vs incidentally. New evidence is presented on outcomes for nodules detected by screening vs incidentally managed pathways.
Lung cancer is the leading cause of cancer death in Ireland, causing 20% of all cancer deaths. Incidence in Irish women is increasing rapidly and is more than double the EU average. Lung cancer services in Ireland are currently disorganized and fragmented, with low rates of tissue diagnosis and accurate staging. Improved organization of lung cancer care through early diagnosis, rapid access to diagnostic services, and coordinated multidisciplinary treatment can improve outcomes. These guidelines aim to assist in providing all lung cancer patients with rapid access to high-quality multidisciplinary care.
This document summarizes risk factors and determinants of the most malignant cancer types globally based on a literature review. It finds that smoking is the leading cause of cancer deaths worldwide and links various other factors like unhealthy diet, alcohol consumption, infections, and environmental pollution to increased cancer risks. It also examines differences in cancer rates by gender, age, and world region, finding for example that lung cancer deaths are much higher in men than women globally. Future challenges for reducing cancer rates include growth and aging of the population worldwide.
This study analyzed cancer mortality patterns over 14 years at a teaching hospital in Lagos, Nigeria. A total of 1436 cancer deaths were recorded out of 30,287 total deaths. The male to female ratio of cancer deaths was 1:2.2. The peak age of death was 51-60 years. Breast cancer accounted for the most cancer deaths at 25.6% of the total. The study aims to provide data on cancer mortality patterns in Nigeria where data is limited, and recommends increased screening for early detection and reduction of mortality.
Here are some potential treatments that could be offered for this patient based on the information provided:
- Bisphosphonates (e.g. zoledronic acid) to reduce high calcium levels and prevent further bone destruction from metastases. Bisphosphonates are commonly used to treat hypercalcemia and bone metastases.
- Radiotherapy to the bone metastases to help reduce pain. Radiotherapy is often used palliatively for painful bone metastases.
- Denosumab, a RANK ligand inhibitor, to treat bone metastases and reduce skeletal related events like pathologic fractures. Denosumab has been shown to be effective for treating bone metastases.
- Best supportive care focused on pain management. Given the extent
This slide presentation is about Lung Cancer. It covers symptoms, standard AMA treatment and what Acupuncture and Herbal Medicine can to to assist in integrative and palliative care. You get the best care and treatment when you combine the benefits of an integrative team of physicians and caregivers.
I made this 15 minute presentation in the 4th year of my Masters program at Emperors College in Santa Monica, California.
Feel free to contact me about the presentation or for care at (866)629-8089 x101 or email me at amyers@lamobileacu.com. Thanks and enjoy!
This document discusses bladder cancer, including:
1) It provides an overview of the epidemiology and risk factors for bladder cancer, noting that smoking is the primary risk factor and occupational exposures can also increase risk.
2) It describes the typical presentation of bladder cancer as painless hematuria and discusses diagnostic tests including cystoscopy and urine cytology.
3) It outlines treatment options for bladder cancer depending on stage, including transurethral resection for early-stage disease and radical cystectomy for more advanced cases. Close follow-up is needed due to the high risk of recurrence.
Lung cancer is a malignant tumor that can be categorized as small cell or non-small cell. Small cell lung cancer grows faster but is more responsive to chemotherapy. It can be limited, confined to the chest, or extensive, having spread outside the chest. Symptoms often appear after the cancer has invaded tissues or spread. Small cell lung cancer accounts for 20% of lung cancer cases and has a median survival of 16-24 months with treatment for limited stage disease. Risk factors include cigarette smoking and second-hand smoke exposure. Treatment depends on stage and typically involves chemotherapy and radiation.
Cancer is caused by abnormal cell growth that spreads uncontrollably. It develops through a complex interaction between genes, environment, and chance. Cancer cells do not die like normal cells and continue growing and dividing in a disorderly fashion. The media needs to accurately report on cancer research studies and not oversimplify results or mislead the public. The UK has higher cancer death rates than some other countries, which may be partly due to lower spending on cancer medications.
This document discusses cancers that can affect the urinary system, including bladder cancer, kidney (renal cell) cancer, and prostate cancer. It provides statistics on incidence and mortality rates for these cancers in the UK and US. Risk factors are described such as exposure to carcinogens for bladder cancer and hereditary factors for kidney cancer. Symptoms and screening of prostate cancer are also outlined.
A 58-year old man who works in a dye factory and smokes cigarettes is experiencing hematuria for 3 months. Urine cytology would be performed to screen for bladder cancer given his risk factors of occupational exposure to carcinogens and smoking history. Proper collection of the second morning voided urine sample is important for accurate cytology results. The patient is most likely to have transitional cell carcinoma of the bladder due to his risk factors, and this type of bladder cancer has different grades based on how abnormal the cells appear.
White Paper- A non-invasive blood test for diagnosing lung cancerDusty Majumdar, PhD
Lung cancer is the leading cause of cancer death worldwide. While low-dose CT screening can reduce lung cancer mortality, it has low specificity resulting in many false positives and unnecessary invasive follow-ups that increase costs. A blood-based biomarker test could potentially improve the specificity of CT screening by reducing false positives. Exact Sciences and MD Anderson are collaborating to develop a multi-marker blood test to complement CT screening for lung cancer, with the goal of a test that matches or exceeds CT's performance to make screening more effective and cost-efficient.
A DVT is a blood clot that forms in the lower extremities, usually starting in the calf veins and extending proximally. Risk factors include obesity, prolonged immobility, cancer, smoking, estrogen use, advancing age, varicose veins, dehydration, splenectomy, and orthopedic procedures. If untreated, a DVT can become serious if the clot breaks off and travels to the lungs (pulmonary embolism), which can be life-threatening. Diagnosis involves ultrasound imaging of the legs.
This Guide for Executives is aimed at senior healthcare leaders. It provides 31 practical tips for leaders
who want to contribute positively to the culture for innovation in their organisations and systems.
A more in-depth practitioners guide, Creating the Culture for Innovation, provides much more
detailed advice and guidance, a host of additional examples, and information about an online staff
survey that can be used to assess, benchmark and understand the culture for innovation.
The Sustainability Model is a diagnostic tool that will identify strengths and
weaknesses in your implementation plan and predict the likelihood of sustainability
for your improvement initiative.
The Sustainability Guide provides practical advice on how you might increase the
likelihood of sustainability for your improvement initiative.
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This study analyzed cancer mortality patterns over 14 years at a teaching hospital in Lagos, Nigeria. A total of 1436 cancer deaths were recorded out of 30,287 total deaths. The male to female ratio of cancer deaths was 1:2.2. The peak age of death was 51-60 years. Breast cancer accounted for the most cancer deaths at 25.6% of the total. The study aims to provide data on cancer mortality patterns in Nigeria where data is limited, and recommends increased screening for early detection and reduction of mortality.
Here are some potential treatments that could be offered for this patient based on the information provided:
- Bisphosphonates (e.g. zoledronic acid) to reduce high calcium levels and prevent further bone destruction from metastases. Bisphosphonates are commonly used to treat hypercalcemia and bone metastases.
- Radiotherapy to the bone metastases to help reduce pain. Radiotherapy is often used palliatively for painful bone metastases.
- Denosumab, a RANK ligand inhibitor, to treat bone metastases and reduce skeletal related events like pathologic fractures. Denosumab has been shown to be effective for treating bone metastases.
- Best supportive care focused on pain management. Given the extent
This slide presentation is about Lung Cancer. It covers symptoms, standard AMA treatment and what Acupuncture and Herbal Medicine can to to assist in integrative and palliative care. You get the best care and treatment when you combine the benefits of an integrative team of physicians and caregivers.
I made this 15 minute presentation in the 4th year of my Masters program at Emperors College in Santa Monica, California.
Feel free to contact me about the presentation or for care at (866)629-8089 x101 or email me at amyers@lamobileacu.com. Thanks and enjoy!
This document discusses bladder cancer, including:
1) It provides an overview of the epidemiology and risk factors for bladder cancer, noting that smoking is the primary risk factor and occupational exposures can also increase risk.
2) It describes the typical presentation of bladder cancer as painless hematuria and discusses diagnostic tests including cystoscopy and urine cytology.
3) It outlines treatment options for bladder cancer depending on stage, including transurethral resection for early-stage disease and radical cystectomy for more advanced cases. Close follow-up is needed due to the high risk of recurrence.
Lung cancer is a malignant tumor that can be categorized as small cell or non-small cell. Small cell lung cancer grows faster but is more responsive to chemotherapy. It can be limited, confined to the chest, or extensive, having spread outside the chest. Symptoms often appear after the cancer has invaded tissues or spread. Small cell lung cancer accounts for 20% of lung cancer cases and has a median survival of 16-24 months with treatment for limited stage disease. Risk factors include cigarette smoking and second-hand smoke exposure. Treatment depends on stage and typically involves chemotherapy and radiation.
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A more in-depth practitioners guide, Creating the Culture for Innovation, provides much more
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survey that can be used to assess, benchmark and understand the culture for innovation.
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Great progress has been made in improving service standards and access and in reducing
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- Slit lamp examination (including fundus)
- Perform biometry and focimetry
- Decide appropriateness for surgery
- Perform auto-refraction
- Discuss desired post-operative refractive status
with the patient (including current type of
spectacle correction) to enable the choice of lens
implant
- Perform ECG and blood tests
- Identify 2nd eye surgery where appropriate
Benefits
- reduces duplication of tasks
- reduces waiting time for patients
- frees up nursing time for other duties
- ensures all key tasks are completed in one visit
- improves patient experience
- reduces overall time in clinic
09
The Preferred Priorities for Care (PPC) is a tool that:
1. Facilitates discussions about end of life care wishes and preferences which can then be recorded.
2. Enables communication across care providers for care planning and decisions.
3. Acts as an advance statement if the person loses capacity, allowing their previously expressed wishes to inform best interest decisions about their care.
The PPC records an individual's end of life care preferences but these may change, so current views should take precedence. It is a voluntary and non-binding document but informs best interest decisions if capacity is lost.
The document discusses key principles for designing end-of-life care environments. It notes that the physical environment can directly impact patient experience and the memories of family and caregivers. Design should facilitate privacy, dignity, and respect. Key principles include being fit for purpose, providing comfort and connection to nature, use of natural light and materials, clarity of wayfinding, and enabling patient control and privacy. Improving environmental design can enhance patient and family experience through intuitive wayfinding, access to nature, consideration of heightened senses, provision of informal spaces, and co-located bereavement services. An environmental improvement project requires forming a multidisciplinary team to review needs, develop a plan and budget, and implement high quality design standards.
The Fast Track Tool is used to gain immediate access to funding for individuals who need urgent care packages due to rapidly deteriorating health conditions that may be terminal. It can be completed by nurses or doctors familiar with the patient's needs. The tool must be used when urgent continuing healthcare is required and replaces the regular assessment process. Patient consent is required unless they lack capacity, in which case clinicians make a best interests decision. Evidence of a completed Fast Track Tool is sufficient for eligibility and PCTs must accept and immediately action properly completed tools.
Support Sheet 13: Decisions made in a person's 'Best Interests'
This support sheet outlines the process for making decisions on behalf of someone who lacks capacity.
Support Sheet 12: Mental Capacity Act (2005)
This support sheet outlines the main provisions of the Mental Capacity Act the four tests essential for assessing capacity
Support Sheet 11: Quality Markers for Acute Hospitals
This support sheet outlines the quality markers by which acute hospitals can measure the standard of end of life care they provide.
Support Sheet 7: Models/Tools of Delivery
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Advance Care Planning (ACP)
Gold Standards Framework (GSF)
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There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
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- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
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- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
1. Deaths from urological cancers in
England, 2001–10
Revised November 2012
www.endoflifecare-intelligence.org.uk
2. National End of Life Care Intelligence Network
Deaths from urological cancers in England, 2001–10
Foreword
Urological cancers are a significant cause of death in England. In the last decade about 1
in 30 deaths were attributable to a urological cancer, and at least 1 in 23 died with a
urological cancer. More men, about 1 in 17, die from urological cancers than women, at 1
in 100. However, it is already known that the survival from certain urological cancers, for
example bladder, is worse in women.
The urological cancers present a number of challenges for end of life care as they
comprise a group of cancers which are disparate in their presentation and prognosis, and
as such have a variety of complications and special needs. Two of the cancers, testicular
and penile, are often managed at specialist centres which may be geographically remote
from a person’s place of residence. Testicular cancer in particular primarily affects younger
men, and their support network is likely to be different from those who die at an old age.
On the whole, people dying from urological cancer are less likely to die in hospital than
people dying from other causes, but this masks large variation: from 35% to 65% of deaths
depending on age and type of cancer. Most people express a preference to die at home
but it is clear that the chances of this happening are variable.
Hospital usage in the last year of life varies widely in terms of number of admissions and
length of stay. Emergency admissions tend to be longer than planned admissions hence
more time is spent away from home and family. They are also more expensive to the NHS.
From the patient’s and their family’s perspective, spending precious days in hospital in the
last months of life is undesirable if it can be avoided. This study highlights the fact that
many patients with urological cancers will have emergency admissions to hospital in their
last months and days of life due to complications of advanced disease.
I look forward to the next phase of work, which will focus on trying to identify the reasons
for these admissions and whether care could be provided in a more effective and
compassionate way in the community.
Professor Sir Mike Richards
National Clinical Director for End of Life Care
1
3. National End of Life Care Intelligence Network
Deaths from urological cancers in England, 2001–10
Contents
Foreword ....................................................................................................................... 1
Summary ....................................................................................................................... 3
1
Introduction....................................................................................................... 5
1.1
Background ........................................................................................................ 5
1.2
Aims .................................................................................................................... 5
2
Methodological notes ...................................................................................... 6
2.1
Source of data .................................................................................................... 6
2.2
Analysis .............................................................................................................. 6
2.3
Place of death..................................................................................................... 6
2.4
Analysis by deprivation quintile .......................................................................... 6
2.5
Cause of death ................................................................................................... 7
2.6
Hospital activity and costs .................................................................................. 7
3
Results ............................................................................................................... 8
3.1
Underlying cause of death .................................................................................. 8
3.2
Underlying cause of death by sex .................................................................... 10
3.3
Underlying cause of death by age .................................................................... 11
3.4
Underlying cause of death by age and sex ...................................................... 13
3.5
Underlying cause of death by deprivation ........................................................ 14
3.6
Cause of death – any mention on the death certificate .................................... 15
3.7
Place of death................................................................................................... 18
3.8
Place of death by region ................................................................................... 24
4
Hospital activity and costs in the last year of life ....................................... 25
5
Conclusions and recommendations ............................................................ 28
Further reading ........................................................................................................... 29
References .................................................................................................................. 30
November 2012 revision ............................................................................................ 30
2
4. National End of Life Care Intelligence Network
Deaths from urological cancers in England, 2001–10
Summary
Introduction
This report presents the latest available data on deaths from urological cancers in England.
Urological cancers include penile, prostate, testicular, kidney, renal pelvis and ureter, and
bladder cancers. The aim of the report is to help end of life care commissioners and
providers improve planning and service delivery in line with the needs and wishes of
patients.
People dying with a urological cancer will have specific end of life care needs. The report
highlights variations by cancer type, age, sex, region, place of death and socioeconomic
status, which help us understand those needs better.
The report also includes information on hospital admission costs in the last year of life and
how they vary by type of urological cancer.
Key findings
Nearly 16,000 people die from a urological cancer each year, and about 5,000
more die with a urological cancer as a contributory cause.
Urological cancers account for 3.3% of all deaths, and over half of these are from
prostate cancer.
Variations by age and sex
When taken as a percentage of all deaths for that sex, more men (5.8%) die from
urological cancers than women (1%). This reflects the patterns of incidence.
62% of urological cancer deaths occur in those aged 65–84. Testicular cancer
shows a different pattern with 79% of deaths in under 65s.
As a proportion of all deaths in that age group, kidney and testicular cancer deaths
are highest in the under 65s. All other urological cancer deaths are highest in the
65–84 age group.
Variations by cause and place of death
The proportional increase in deaths which mention urological cancer over deaths
caused by urological cancer is greatest for prostate cancer. The proportion of all
male deaths which have a mention of prostate cancer is 5.2% overall but this
increases to 6.9% (2.3% of people) for those men dying aged 85 or older.
Hospital is the main place of death for those dying from a urological cancer, with
46% of deaths occurring in hospital. This is lower than the average for all deaths
which is 54% (2008–10 data). 23% of urological cancer deaths occur in people’s
own homes.
There is variation in place of death by urological cancer type, with testicular cancer
patients most likely to die in hospital and kidney cancer patients most likely to die
at home.
There is also regional variation in place of death, which mirrors the variation in allcause place of death. In London, 53% of urological cancer deaths are in hospital.
In the South West, 25% of urological cancer deaths are at home.
3
5. National End of Life Care Intelligence Network
Deaths from urological cancers in England, 2001–10
Variations by time spent in hospital and cost in the last year of life
The amount of time spent in hospital and the cost of inpatient care in the last year
of life varies between the urological cancer types.
Emergency admissions tend to be longer and more costly. In the three largest
groups (prostate, bladder and kidney cancers), emergency admissions are more
common than planned admissions.
The final admission is more costly than the last year of life average, even for those
not dying in hospital. Between one-quarter (testicular cancer) and one-half
(prostate cancer) of the total cost is accounted for by the final admission.
The highest inpatient costs in the last year of life are for testicular cancers, at just
over £13,000 per person. Prostate cancer has the lowest cost at less than £7,000
per person.
Conclusions and recommendations
The variations presented in this report should inform the local commissioning and delivery
of end of life care for urological cancer patients.
The differences, for example, in age profiles are important as they will determine the needs
of the individuals affected, along with their families and carers. They also determine where
people are likely to receive end of life care at the time of their final illness.
People dying with a urological cancer recorded as either an underlying or contributory
cause of death are likely to have specific end of life care needs related to these conditions,
which need to be taken into account.
The variation in hospital activity and costs between urological cancers is to some extent
due to inherent variation in complications and the profile of people dying from these
cancers. However, in all cases emergency admissions are longer and more costly.
Services which help avoid emergency admissions should be considered as they will benefit
both the patient (in terms of reduced hospital stay) and reduce total expenditure. End of life
care needs to be considered within the broader spectrum of ‘overall care’ for individuals
living with a urological cancer. This could be achieved through raising awareness and
enhancing skills for clinical staff working in cancer medicine. Appropriate configuration of
services and infrastructure may improve patient and family/carer experience with possibly
a need for better responsiveness and pre-emptive management.
Feedback
We welcome your feedback about this report. Please send comments to
info@swpho.nhs.uk
4
6. National End of Life Care Intelligence Network
1
Deaths from urological cancers in England, 2001–10
Introduction
1.1 Background
The incidence of urological cancers for the most recently available year, 2010, was 54,231.
The most common urological cancer types are prostate and bladder.
Incidence of urological cancers generally follows the trend for all cancers, i.e. it is more
common in men and increases with age. The notable exception is testicular cancer, which
is most common in men aged under 40.
Survival from urological cancers varies by type and also by sex. One-year survival in 2009
was 98% for men diagnosed with testicular cancer, but only 64% for women diagnosed
with bladder cancer.
16,602 people died from a urological cancer in 2010 and the pattern of deaths reflects the
patterns of incidence; with prostate and bladder cancer deaths the highest.
Three percent (3.3%) of all deaths in England in the ten-year period 2001–10 were from
urological cancers, that is, a urological cancer was recorded as the underlying cause on
the death certificate.
The proportion of all deaths in England with a mention of urological cancer on the death
certificate, in the same time period, was four percent (4.3%).
1.2 Aims
The aim of this report is to analyse and present the latest data on place of death for those
dying from a urological cancer and how this varies with gender, age, socioeconomic
deprivation and place. The report is based on Office for National Statistics (ONS) mortality
data.
The report was commissioned by the National End of Life Care Intelligence Network to
support national end of life care service planning and development.
National strategy and policy supporting this work includes:
The National End of Life Care Strategy (Department of Health, 2008)
Public Health Outcomes Framework (Department of Health, 2012).
In addition, a national strategy for urological cancer is currently being produced by the
Department of Health.
5
7. National End of Life Care Intelligence Network
2
Deaths from urological cancers in England, 2001–10
Methodological notes
2.1 Source of data
All data presented in this report are from the Office for National Statistics (ONS) mortality
files. The mortality files contain extracts from death certificates. Key data items used for
this analysis include place of death, postcode of ‘usual’ place of residence, date of birth,
sex and cause of death. Mortality data are available up to 2010.
2.2 Analysis
Data in this report are presented as absolute numbers and proportions rather than agespecific or age-standardised rates to support service planning.
2.3 Place of death
The ONS describes place of death as one of 84 communal establishment types or ‘own
residence’ or ‘elsewhere’. These are categorised further by ONS in their DH1 General
Mortality Statistics publication:
Hospital: NHS or non-NHS, acute, community or psychiatric hospitals/units.
Own residence: the death occurred in the place of usual residence where this is
not a communal establishment.
Old people’s home: Local Authority or private residential home.
Nursing home: NHS or private nursing home.
Hospice: many hospices are ‘free standing’ but some are found within NHS
hospitals. At present ONS classifies the place of death as hospice only when the
event occurred in a free standing hospice premises. These data will therefore
under-report deaths in hospices as some will be recorded as deaths in hospital.
Elsewhere: other communal establishment or a private address other than usual
place of residence or outdoor location or nil recorded.
2.4 Analysis by deprivation quintile
Lower Super Output Areas (LSOAs) are small geographical areas specifically devised to
improve the reporting and comparison of local statistics. In England there are 32,482
LSOAs with a minimum population of 1,000, and an average population of 1,500.
LSOAs are grouped into quintiles of deprivation based on the income deprivation score
from the 2007 Indices of Deprivation, with each quintile having as close as possible to onefifth of the English population. The income deprivation score measures the percentage of
children and adults living in ‘income deprived’ households, based on a number of
definitions.
The residential postcode recorded on the death certificate was used to place each
deceased person in an LSOA and assign that death to the deprivation quintile of the LSOA.
6
8. National End of Life Care Intelligence Network
Deaths from urological cancers in England, 2001–10
2.5 Cause of death
The single ‘underlying’ cause of death is determined from the death certificate by the ONS
and coded using the ICD-10 system (International Classification of Disease, tenth issue).
This coding system is used to categorise cause of death in this report as follows:
Type
ICD-10 Code
Penile cancer
C60
Prostate cancer
C61
Testicular cancer
C62
Kidney cancer
C64
Renal pelvis and ureter cancers
C65, C66
Bladder cancer
C67
The underlying cause of death is defined by the World Health Organisation as “the disease
or injury that initiated the train of events directly linked to death; or the circumstances of the
accident or violence that produced the fatal injury” and is the cause of death data recorded
on a death certificate.
Death certificates also record ‘contributory cause’ of death, where a disease or condition
has contributed to the death but is not part of the causal sequence, and also up to 15
diseases or conditions which were part of the causal sequence of events leading to death.
For the purpose of this report, ‘mentions’ refer to those deaths where a urological cancer is
recorded as either the underlying or contributory cause of death.
2.6 Hospital activity and costs
Admissions, length of stay and costs of inpatient activity in the last year of life are
calculated from a linked dataset of ONS mortality data and hospital activity data from
Hospital Episode Statistics. Data are available from 2004–08.
All persons dying from a urological cancer in 2006–08 were selected, and the number of
admissions and length of stay in hospital in the year before death calculated. Healthcare
Resource Group 3.5 codes are used to calculate the cost of care, taking into account
whether admissions were emergency or elective and length of stay. The 2007/08
Department of Health ‘Payment by Results’ tariff was used for costs calculations.
No costs for outpatient or home care are included, as data for these are not available.
Depending on the complications caused by particular cancers, and the management of the
disease, outpatient/home care may make up different proportions of the cost of care.
7
9. National End of Life Care Intelligence Network
3
Deaths from urological cancers in England, 2001–10
Results
3.1 Underlying cause of death
Three percent (3.3%) of all deaths in England for the period 2001–10 are recorded
as having an underlying cause of urological cancer.
Figure 1 shows urological cancer causes of death in absolute numbers and
proportions respectively.
The most common cause of urological cancer death is prostate cancer
(approximately 1.8% of all deaths in England and 55% of urological cancer deaths;
8,596 deaths annually).
Bladder cancer accounts for about 0.9% of all deaths in England and 26% of
urological cancer deaths (4,112 deaths annually).
Kidney cancer accounts for approximately 0.6% of all deaths in England and 18%
of urological cancer deaths (2,778 deaths annually).
Figure 1: Deaths from urological cancer, as a percentage of deaths from all causes, 2001–10
(with average deaths per year)
2.0
n = 8,596
1.8
Percentage of deaths from all causes
1.6
1.4
1.2
1.0
n = 4,112
0.8
n = 2,778
0.6
0.4
0.2
n = 87
n = 124
n = 59
0.0
Penile
cancer
Prostate
cancer
Testicular
cancer
Kidney
cancer
Renal pelvis &
ureter cancers
Bladder
cancer
Cause of death
Source: ONS mortality data
Figures 2 and 3 show that although absolute numbers of deaths from
urological cancers vary by region (due to differing population size), the
proportion of deaths from each cause is similar.
The South East has the greatest number of deaths from urological cancers
with 2,683 deaths per year on average. The South West has the greatest
proportion of deaths from prostate cancer (57% of all urological cancer
deaths).
8
10. National End of Life Care Intelligence Network
Deaths from urological cancers in England, 2001–10
Figure 2: Deaths from urological cancers, by former Government Office region and cause,
average deaths per year, 2001–10
3,000
Number of deaths per year
2,500
2,000
1,500
1,000
500
0
East
Midlands
East of
England
London
North
East
North
West
South
East
South
West
Former government office regions
Penile cancer
Kidney cancer
Prostate cancer
Renal pelvis & ureter cancers
West
Yorkshire
Midlands and the
Humber
Testicular cancer
Bladder cancer
Source: ONS mortality data
Figure 3: Deaths from urological cancers by former Government Office region and cause,
contribution to total from each cause, 2001–10
100
Percentage of deaths from urological cancers
90
80
70
60
50
40
30
20
10
0
East
Midlands
East of
England
London
North
East
North
West
South
East
Former government office regions
Penile cancer
Kidney cancer
Prostate cancer
Renal pelvis & ureter cancers
Source: ONS mortality data
9
South
West
West
Yorkshire
Midlands and the
Humber
Testicular cancer
Bladder cancer
11. National End of Life Care Intelligence Network
Deaths from urological cancers in England, 2001–10
3.2 Underlying cause of death by sex
Figures 4 and 5 indicate that more deaths from bladder cancer and kidney cancer
occurred amongst males (2,736 deaths per year, 1.2% of all male deaths and
1,710 deaths per year, 0.7% of all male deaths respectively) compared to females
(1,376 deaths per year, 0.5% of all female deaths and 1,067 deaths per year, 0.4%
of all female deaths respectively). There were 72 deaths per year in males from
cancer of renal pelvis and ureter, compared to 52 per year in women.
The greater number of deaths in males is reflective of patterns of incidence, as all
urological cancers are more common in males.
Figure 4: Deaths from urological cancers by sex, average deaths per year, 2001–10
10,000
9,000
Number of deaths per year
8,000
7,000
6,000
5,000
4,000
3,000
2,000
1,000
0
Penile
cancer
Prostate
cancer
Testicular
cancer
Cause of death
Males Females
Source: ONS mortality data
10
Kidney
cancer
Renal pelvis &
ureter cancers
Bladder
cancer
12. National End of Life Care Intelligence Network
Deaths from urological cancers in England, 2001–10
Figure 5: Deaths from urological cancers by sex, as a percentage of deaths from all causes,
2001–10
4.0
Percentage of deaths from all causes
3.5
3.0
2.5
2.0
1.5
1.0
0.5
0.0
Penile
cancer
Prostate
cancer
Testicular
cancer
Kidney
cancer
Renal pelvis &
ureter cancers
Bladder
cancer
Cause of death
Males
Females
Source: ONS mortality data
3.3 Underlying cause of death by age
Figure 6 shows that the total number of deaths from urological cancers is greatest
in the 65–84 age group (9,757 deaths per year), followed by the 85+ age group
(4,043 deaths per year) and those aged <65 (1,956 deaths per year).
The number of prostate cancer deaths is highest for those aged 65–84 (5,514
deaths per year).
Deaths from urological cancers as a proportion of deaths from all causes is highest
in the 65–84 age group. In this age group, 1 in 25 deaths is from a urological
cancer, most of them from prostate cancer (Figure 7).
Table 1 presents the proportion of deaths from all urological cancer causes (also
shown in Figure 7). These proportions vary considerably by age group for each
cause of death and are lowest for deaths at <65 years for every cause, except
kidney cancer and testicular cancer.
11
13. National End of Life Care Intelligence Network
Deaths from urological cancers in England, 2001–10
Figure 6: Deaths from urological cancers by age, average deaths per year, 2001–10
12,000
Number of deaths per year
10,000
8,000
6,000
4,000
2,000
0
<65
65-84
85+
Age at death
Penile cancer
Kidney cancer
Prostate cancer
Renal pelvis & ureter cancers
Testicular cancer
Bladder cancer
Source: ONS mortality data
Figure 7: Deaths from urological cancers by age, as a percentage of deaths from all causes,
2001–10
4.5
4.0
Percentage of all deaths
3.5
3.0
2.5
2.0
1.5
1.0
0.5
0.0
<65
65-84
85+
Age at death
Penile cancer
Kidney cancer
Prostate cancer
Renal pelvis & ureter cancers
Source: ONS mortality data
12
Testicular cancer
Bladder cancer
14. National End of Life Care Intelligence Network
Deaths from urological cancers in England, 2001–10
Table 1: Deaths from urological cancers by age, as a percentage of deaths from all causes,
2001–10
<65
%
Underlying cause
Age at death
65–84
%
85+
%
Penile cancer
0.0
0.0
0.0
Prostate cancer
0.7
2.3
1.5
Testicular cancer
0.1
0.0
0.0
Kidney cancer
1.0
0.7
0.2
Renal pelvis & ureter cancers
0.0
0.0
0.0
Bladder cancer
0.6
1.1
0.7
Source: ONS mortality data
3.4 Underlying cause of death by age and sex
Figures 8 and 9 show that both the number and percentage of deaths from
urological cancers is higher in males than females for all age groups.
The percentage of deaths from prostate cancer is highest in those aged 65–84 and
85+ (4.4% of males aged 65–84 and 4.6% of males aged 85+).
Deaths from bladder cancer is highest in the 65–84 and 85+ age groups for both
males (1.4% of males aged 65–84 and 1.2% of males aged 85+) and females
(0.7% of females aged 65–84 and 0.4% of females aged 85+).
The percentage of deaths from kidney cancer is highest in those aged <65. This is
true for both males (1.1%) and females (0.8%).
Figure 8: Deaths from urological cancers by age and sex, average deaths per year, 2001–10
6,000
Number of deaths
5,000
4,000
3,000
2,000
1,000
0
Males
Females
<65
Penile cancer
Kidney cancer
Males
Females
65-84
Age at death and sex
Prostate cancer
Renal pelvis & ureter cancers
Source: ONS mortality data
13
Males
Females
85+
Testicular cancer
Bladder cancer
15. National End of Life Care Intelligence Network
Deaths from urological cancers in England, 2001–10
Figure 9: Deaths from urological cancers by age and sex, as a percentage of deaths from all
causes, 2001–10
5.0
4.5
4.0
Percentage of all deaths
3.5
3.0
2.5
2.0
1.5
1.0
0.5
0.0
Males
Females
Males
<65
Females
Males
65-84
Females
85+
Age at death and sex
Penile cancer
Kidney cancer
Prostate cancer
Renal pelvis & ureter cancers
Testicular cancer
Bladder cancer
Source: ONS mortality data
3.5 Underlying cause of death by deprivation
There are more deaths in the middle quintile of deprivation than the other quintiles
(Figure 10). The lower number of deaths in the most deprived quintile is probably
due to an overall younger population, as most deaths occur in those aged 65+. The
lower number of deaths in the least deprived quintile is reflective of lower incidence
in this population (prostate cancer excepted).
Figure 10: Deaths from urological cancers by quintile of income deprivation and underlying
cause, percentage of deaths from underlying cause, 2001–10
Percentage of deaths from underlying cause
25
20
15
10
5
0
Penile
cancer
Prostate
cancer
Testicular
cancer
Kidney
cancer
Renal pelvis &
ureter cancers
Bladder
cancer
Cause of death
1 Least deprived
2
3
Source: ONS mortality data
14
4
5 Most deprived
16. National End of Life Care Intelligence Network
Deaths from urological cancers in England, 2001–10
3.6 Cause of death – any mention on the death
certificate
In this section, we examine the number and proportion of deaths for which a urological
cancer is recorded as either the underlying cause of death or as a contributory cause,
defined here as ‘mentions’ (see Section 2.5). The proportion of all deaths in England with a
mention of urological cancer on the death certificate in 2001–10 is 4.3%.
Figures 11 and 12 show the number and proportion of deaths where a urological
cancer is mentioned on the death certificate, compared to the underlying cause of
death alone. Counting mentions makes the biggest difference for prostate cancer,
increasing the number of deaths per year to 11,768, approximately 2.5% of all
deaths in England.
Figures 13 and 14 show that, for each cause, the number and proportion of deaths
with a mention of urological cancer on the death certificate is greatest in males.
Figure 11: Deaths from urological cancers, as underlying cause and as total mentions on
death certificate, average deaths per year, 2001–10
14,000
Number of deaths per year
12,000
10,000
8,000
6,000
4,000
2,000
0
Penile
cancer
Prostate
cancer
Testicular
cancer
Kidney
cancer
Cause of death
Underlying cause
Any mention
Source: ONS mortality data
15
Renal pelvis &
ureter cancers
Bladder
cancer
17. National End of Life Care Intelligence Network
Deaths from urological cancers in England, 2001–10
Figure 12: Deaths from urological cancers, as underlying cause and total mentions on death
certificate, percentage of deaths from all causes, 2001–10
3.0
Percentage of all deaths
2.5
2.0
1.5
1.0
0.5
0.0
Penile
cancer
Prostate
cancer
Testicular
cancer
Kidney
cancer
Renal pelvis &
ureter cancers
Bladder
cancer
Cause of death
Underlying cause
Any mention
Source: ONS mortality data
Figure 13: Deaths from urological cancers by sex, total mentions on death certificate,
average deaths per year, 2001–10
14,000
Number of deaths per year
12,000
10,000
8,000
6,000
4,000
2,000
0
Male Female Male Female Male Female Male Female Male Female Male Female
Penile cancer Prostate cancer
Testicular
cancer
Kidney cancer
Cause of death and sex
Underlying cause
Any mention
Source: ONS mortality data
16
Renal pelvis & Bladder cancer
ureter cancers
18. National End of Life Care Intelligence Network
Deaths from urological cancers in England, 2001–10
Figure 14: Deaths from urological cancers by sex, total mentions on death certificate,
percentage of deaths from all causes, 2001–10
6
Percentage of deaths from all causes
5
4
3
2
1
0
Male
Female
Penile cancer
Male
Female
Male
Female
Male
Female
Prostate cancer Testicular cancer Kidney cancer
Male
Female
Male
Renal pelvis &
ureter cancers
Female
Bladder cancer
Cause of death and sex
Underlying cause
Any mention
Source: ONS mortality data
Tables 2 and 3a and 3b demonstrate the large difference between deaths from
prostate cancer and the deaths of men dying with prostate cancer. This difference
is especially apparent in those aged 85 and over, with 1.5 times as many mentions
on death certificates as underlying causes of death.
The highest rate of kidney cancer deaths and mentions, as a proportion of deaths
for that age group, is in those aged under 65.
The highest rate of bladder cancer deaths and mentions, as a proportion of deaths
for that age group, is in those aged 65-84.
Table 2: Deaths from urological cancers by sex, underlying cause and total mentions on death
certificate, as percentage of deaths from all causes, 2001–10
Males
Cancer type
Underlying cause %
Females
Any mention %
Underlying cause %
Any mention %
Penile
0.0
0.0
-
-
Prostate
3.8
5.2
-
-
Testicular
0.0
0.0
-
-
Kidney
0.7
0.9
0.4
0.5
Renal pelvis & ureter
0.0
0.0
0.0
0.0
Bladder
1.2
1.6
0.5
0.7
17
19. National End of Life Care Intelligence Network
Deaths from urological cancers in England, 2001–10
Table 3a: Deaths from urological cancers by age, underlying cause and total mentions on
death certificate, as percentage of all deaths from all causes, 2001-10
<65
Underlying
cause %
Cancer type
65-84
Any
Underlying
mention %
cause %
85+
Any
Underlying
mention %
cause %
Any
mention %
Penile
0.0
0.0
0.0
0.0
0.0
0.0
Prostate
0.7
0.8
2.3
3.1
1.5
2.3
Testicular
0.1
0.1
0.0
0.0
0.0
0.0
Kidney
1.0
1.1
0.7
0.8
0.2
0.3
Renal pelvis & ureter
0.0
0.0
0.0
0.0
0.0
0.0
Bladder
0.6
0.6
1.1
1.4
0.7
1.0
Table 3b: Deaths from urological cancers by age, underlying cause and total mentions on
death certificate, as percentage of all male deaths from all causes 2001–10
Cancer type
<65
65-84
85+
Underlying
Any
Underlying
Any
Underlying
Any
cause % mention %
cause % mention %
cause % mention %
Penile
0.1
0.0
0.0
0.0
0.0
0.0
Prostate
1.2
1.3
4.4
5.9
4.6
6.9
Testicular
0.1
0.1
0.0
0.0
0.0
0.0
3.7 Place of death
Figures 15 and 16 show the number and proportion of deaths for each urological cancer by
place of death.
The most common place of death for urological cancer patients is hospital (46%).
This is a lower proportion than for deaths in hospital from any cancer (48%) or of
any cause (58%) during 2001–10 (for most recent data, 2008–10, this has fallen to
54%).
Testicular cancer and bladder cancer have the largest proportion of deaths
occurring in hospital, at 57% and 51% of deaths in their individual cause categories
respectively (Figure 16).
The largest proportion of deaths occurring at home is for kidney cancer (26%).
Prostate, bladder and kidney cancers all have the same pattern, with most deaths
occurring in hospital, followed by own home, then hospice.
However, there are more deaths in hospice than at home for penile cancer, and
renal pelvis and ureter cancer patients.
18
20. National End of Life Care Intelligence Network
Deaths from urological cancers in England, 2001–10
Figure 15: Deaths from urological cancers by place of death and underlying cause, average
deaths per year, 2001–10
4,500
4,000
Number of deaths per year
3,500
3,000
2,500
2,000
1,500
1,000
500
0
Penile
cancer
Prostate
cancer
Testicular
cancer
Kidney
cancer
Renal pelvis &
ureter cancers
Bladder
cancer
Cause of death
Elsewhere
Hospital
Hospice
Nursing home
Old people's home
Own home
Source: ONS mortality data
Figure 16: Deaths from urological cancers by place of death and underlying cause,
percentage of deaths from underlying cause, 2001–10
100
Percentage of deaths from underlying cause
90
80
70
60
50
40
30
20
10
0
Penile
cancer
Prostate
cancer
Testicular
cancer
Kidney
cancer
Renal pelvis &
ureter cancers
Bladder
cancer
Cause of death
Elsewhere
Hospital
Hospice
Nursing home
Old people's home
Own home
Source: ONS mortality data
For those dying from penile cancer (Figure 17), the age group with the largest
proportion of deaths in hospital is 65–84 (48%). This compares to 37% of those
aged 85+.
Overall, the proportion of deaths from prostate cancer that occur in the person’s
own home is higher than for most other urological cancers (Figure 18). Most
prostate cancer deaths still occur in hospital, and this increases with age, from
39% in under 65s to 47% in over those aged 85 and over.
19
21. National End of Life Care Intelligence Network
Deaths from urological cancers in England, 2001–10
Figure 19 shows that, of those who die of testicular cancer, a higher proportion of
the 65–84 age group die in hospital (64%) than in the other age groups.
Deaths in hospital from kidney cancer increase with age (Figure 20). There is a
corresponding decrease in the proportion of deaths occurring in a hospice or own
home.
Younger people dying from cancers of the renal pelvis and ureter have the highest
proportion of deaths at home (Figure 21): a third of those aged <65 die in their own
home.
Figure 22 shows that for bladder cancer, hospital is the most common place of
death for all ages. Those aged under 65 have the highest percentage of deaths
occurring in a hospice (25%) or in their own home (27%).
The general trend of younger patients being more likely to die at home is reflective
of the increased likelihood of having family to offer support and care.
Figure 17: Deaths from penile cancer by age and place of death, percentage of deaths in
each age group, 2001–10
60
Percentage of deaths in age group
50
40
30
20
10
0
Elsewhere
Hospital
Hospice
Nursing homes
Place of death
<65
65-84
Source: ONS mortality data
20
85+
Old people's home
Own home
22. National End of Life Care Intelligence Network
Deaths from urological cancers in England, 2001–10
Figure 18: Deaths from prostate cancer by age and place of death, percentage of deaths
in each age group, 2001–10
50
Percentage of deaths in age group
45
40
35
30
25
20
15
10
5
0
Elsewhere
Hospital
Hospice
Nursing homes
Old people's home
Own home
Place of death
<65
65-84
85+
Source: ONS mortality data
Figure 19: Deaths from testicular cancer by age and place of death, percentage of deaths
in each age group, 2001–10
70
Percentage of deaths in age group
60
50
40
30
20
10
0
Elsewhere
Hospital
Hospice
Nursing homes
Place of death
<65
65-84
Source: ONS mortality data
21
85+
Old people's home
Own home
23. National End of Life Care Intelligence Network
Deaths from urological cancers in England, 2001–10
Figure 20: Deaths from kidney cancer by age and place of death, percentage of deaths in
each age group, 2001–10
50
Percentage of deaths in age group
45
40
35
30
25
20
15
10
5
0
Elsewhere
Hospital
Hospice
Nursing homes
Old people's home
Own home
Place of death
<65
65-84
85+
Source: ONS mortality data
Figure 21: Deaths from cancer of the renal pelvis and ureter by age and place of death,
percentage of deaths in each age group, 2001–10
45
Percentage of deaths in age group
40
35
30
25
20
15
10
5
0
Elsewhere
Hospital
Hospice
Nursing homes
Place of death
<65
65-84
Source: ONS mortality data
22
85+
Old people's home
Own home
24. National End of Life Care Intelligence Network
Deaths from urological cancers in England, 2001–10
Figure 22: Deaths from bladder cancer by age and place of death, percentage of deaths in
each age group, 2001–10
60
Percentage of deaths in age group
50
40
30
20
10
0
Elsewhere
Hospital
Hospice
Nursing homes
Place of death
<65
65-84
Source: ONS mortality data
23
85+
Old people's home
Own home
25. National End of Life Care Intelligence Network
Deaths from urological cancers in England, 2001–10
3.8 Place of death by region
The general pattern of place of death, i.e. the largest group being hospital deaths,
is the same across all regions. However, Figures 23 and 24 show that the
percentage of deaths occurring in each place varies. Deaths in hospital range from
42% in the South East to 53% in London, while deaths in the person’s own home,
varies from 19% in London to 25% in the South West.
Figure 23: Deaths from urological cancers by place of death and region, average number
per year, 2001–10
1,200
Number of deaths per year
1,000
800
600
400
200
0
East
Midlands
East of
England
London
North
East
North
West
South
East
South
West
West
Yorkshire
Midlands and the
Humber
Former government office regions
Elsewhere
Hospital
Hospice
Nursing home
Old people's home
Own home
Source: ONS mortality data
Figure 24: Deaths from urological cancers by place of death and region, as percentage
of deaths from all causes, 2001–10
Percentage of all urological cancer deaths
60
50
40
30
20
10
0
East
Midlands
East of
England
London
North
East
North
West
South
East
South
West
West
Yorkshire
Midlands and the
Humber
Former government office regions
Elsewhere
Hospital
Hospice
Nursing home
Source: ONS mortality data
24
Old people's home
Own home
26. National End of Life Care Intelligence Network
4
Deaths from urological cancers in England, 2001–10
Hospital activity and costs in the last
year of life
Tables 4–9 show a breakdown of hospital length of stay and cost in the last year of life, by
urological cancer type, between 2006 and 2008 in England.
The total number of bed days and total cost varies by urological cancer type. The
two biggest causes of urological cancer deaths are prostate cancer (55%) and
bladder cancer (26%). However, proportionally fewer bed days are accounted for
by prostate cancer (49%) and proportionally more (32%) by bladder cancer.
Overall, emergency admissions are longer and more costly. Bladder and renal
pelvis and ureter cancer patients admitted as emergencies have almost double the
length of stay in hospital of those admitted electively – the biggest difference in
length of stay of all the urological cancer types. This may be due to complications
of stomata, urinary diversions and catheters, which are often required in the
treatment of urological cancer patients, but especially in these groups.
Complications include severe pain and intractable bleeding.
For the three main urological cancers (prostate, bladder and kidney), patients have
more emergency than elective admissions in the last year of life. In the less
common urological cancers, the pattern is reversed.
Total cost of inpatient care per person in the last year of life varies from £6,931 for
patients who die of prostate cancer to £13,304 for those who die of testicular
cancer. The markedly higher costs for penile (£10,310) and testicular cancer
deaths may reflect the fact that these cancers are often dealt with in tertiary care
settings. In the case of testicular cancer, the younger age profile may mean that
patients are more suitable for aggressive treatment. Also, the perception of a
greater benefit of survival may make clinicians more willing to persist with all
treatment options.
The final admission, even for those not dying in hospital, is more expensive than
the average admission cost for urological cancers in the last year of life. In those
dying from prostate cancer, the average final admission cost is nearly half (47%) of
the average total last year of life cost. In contrast, in those dying from testicular
cancer the final admission is about one-quarter (23%) of the last year of life cost.
25
27. National End of Life Care Intelligence Network
Deaths from urological cancers in England, 2001–10
Table 4: Admissions, length of stay and cost in the last year of life, for men dying from penile
cancer in 2006–08
Elective
Emergency
Total
Admissions in last year of life
467
441
908
Beddays in last year of life
3,751
5,728
9,479
Average length of stay per admission
8.0
13.0
10.4
Average admissions per person
2.7
2.2
3.8
Length of stay of final admission
14.3
16.1
15.7
Total cost £
Cost per admission £
Cost per person £
Cost of final admission £
1,141,232
2,444
6,521
3,025
1,333,078
3,023
6,567
3,387
2,474,310
2,725
10,310
3,294
Source: ONS mortality data
Table 5: Admissions, length of stay and cost in the last year of life, for men dying from
prostate cancer in 2006–08
Elective
Emergency
Total
Admissions in last year of life
Beddays in last year of life
Average length of stay per admission
Average admissions per person
Length of stay of final admission
Total cost £
Cost per admission £
Cost per person £
Cost of final admission £
8,181
69,482
8.5
1.4
13.3
41,829
530,288
12.7
2.1
15.7
50,010
599,770
12.0
2.4
15.5
15,553,710
1,901
2,691
2,409
126,574,654
3,026
6,448
3,323
142,128,364
2,842
6,931
3,223
Source: ONS mortality data
Table 6: Admissions, length of stay and cost in the last year of life, for men dying from
testicular cancer in 2006–08
Elective
Emergency
Total
Admissions in last year of life
420
327
747
Beddays in last year of life
2,621
3,200
5,821
Average length of stay per admission
6.2
9.8
7.8
Average admissions per person
4.3
2.5
5.3
Length of stay of final admission
13.4
12.0
12.3
Total cost £
Cost per admission £
Cost per person £
Cost of final admission £
1,029,714
2,452
10,507
3,132
Source: ONS mortality data
26
859,428
2,628
6,561
3,008
1,889,142
2,529
13,304
3,034
28. National End of Life Care Intelligence Network
Deaths from urological cancers in England, 2001–10
Table 7: Admissions, length of stay and cost in the last year of life, for people dying from
kidney cancer in 2006–08
Elective
Emergency
Total
Admissions in last year of life
4,352
14,568
18,920
Beddays in last year of life
35,794
171,599
207,393
Average length of stay per admission
8.2
11.8
11.0
Average admissions per person
1.6
2.2
2.6
Length of stay of final admission
12.5
14.7
14.4
Total cost £
Cost per admission £
Cost per person £
Cost of final admission £
10,315,988
2,370
3,691
2,967
43,472,671
2,984
6,448
3,277
53,788,659
2,843
7,501
3,234
Source: ONS mortality data
Table 8: Admissions, length of stay and cost in the last year of life, for people dying from
renal pelvis & ureter cancer in 2006–08
Elective
Emergency
Total
Admissions in last year of life
431
636
1,067
Beddays in last year of life
2,687
8,197
10,884
Average length of stay per admission
6.2
12.9
10.2
Average admissions per person
2.1
1.3
3.1
Length of stay of final admission
11.9
17.0
15.8
Total cost £
Cost per admission £
Cost per person £
Cost of final admission £
1,030,179
2,390
4,837
3,127
1,941,249
3,052
6,386
3,475
2,971,428
2,785
8,588
3,394
Source: ONS mortality data
Table 9: Admissions, length of stay and cost in the last year of life, for people dying from
bladder cancer in 2006–08
Elective
Emergency
Total
Admissions in last year of life
12,159
21,859
34,018
Beddays in last year of life
88,896
297,660
386,556
Average length of stay per admission
7.3
13.6
11.4
Average admissions per person
1.8
2.2
3.1
Length of stay of final admission
13.4
17.5
16.7
Total cost £
Cost per admission £
Cost per person £
Cost of final admission £
23,989,511
1,973
3,592
2,962
Source: ONS mortality data
27
69,467,965
3,178
7,041
3,581
93,457,476
2,747
8,502
3,464
29. National End of Life Care Intelligence Network
5
Deaths from urological cancers in England, 2001–10
Conclusions and recommendations
This report is the first to provide a high-level overview of mortality data from urological
cancers in England. It shows the absolute numbers of deaths, where these are mentioned
as the underlying and contributory causes of deaths.
The report also illustrates the different age profiles of people dying from urological cancers.
These differences in age profiles are important as they will determine the needs of the
individuals affected, along with their families and carers, and also determine where people
are likely to receive end of life care at the time of their final illness.
People dying with a urological cancer recorded as either an underlying or contributory
cause of death are likely to have specific end of life care needs related to these conditions.
This report should be used by policy makers, providers and commissioners of care to the
elderly and patients with urological cancers and to the non-statutory bodies who support
them and their carers.
The variation in hospital activity and costs between urological cancers is to some extent
due to inherent variation in complications and the profile of people dying from these
cancers. However, in all cases, emergency admissions are longer and more costly.
Services which help avoid emergency admissions should be considered as they will benefit
both the patient (in terms of reduced hospital stay) and reduce total expenditure.
End of life care needs to be considered within the broader spectrum of ‘overall care’ for
individuals living with a urological cancer. This could be achieved through raising
awareness and enhancing skills for clinical staff working in cancer medicine. Appropriate
configuration of services and infrastructure may improve patient and family/carer
experience with possibly a need for better responsiveness and pre-emptive management.
28
30. National End of Life Care Intelligence Network
Deaths from urological cancers in England, 2001–10
Further reading
For contextual and supplementary information, we recommend reading this report
alongside:
National Cancer Intelligence Network, (2012). Urological cancer profiles, from:
http://www.ncin.org.uk/cancer_type_and_topic_specific_work/cancer_type_specific_work/u
rological_cancer/urological_cancer_hub/profiles.aspx
National End of Life Care Intelligence Network. (2010). Deaths from Renal Diseases in
England, 2001 to 2008, from: http://www.endoflifecareintelligence.org.uk/resources/publications/deaths_from_renal_diseases.aspx
National End of Life Care Intelligence Network. (2012). Deprivation and death: Variation in
place and cause of death, from: http://www.endoflifecareintelligence.org.uk/resources/publications/deprivation_and_death.aspx
National Institute for Health and Clinical Excellence. (2002). Improving outcomes in
urological cancers, from: http://www.nice.org.uk/CSGUC
Norman, R, W., & Currow, D, C. (2005). Supportive Care for the Urology Patient: Oxford
University Press.
29
31. National End of Life Care Intelligence Network
Deaths from urological cancers in England, 2001–10
References
Department of Health (2008). End of Life Care Strategy: promoting high quality care for all
adults at the end of life, from:
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuida
nce/DH_118810
Department of Health (2012). Healthy Lives, Healthy People: Improving outcomes and
supporting transparency, from:
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuida
nce/DH_132358
November 2012 revision
The average number of urological cancer deaths per year in the 85+ age group was 4,043
in 2001–10 and not 3,452 as previously reported. This has resulted in adjustments to the
following tables and charts and associated text:
Figures 6–9
Figures 17–22
Table 3 (now Tables 3a and 3b)
The changes do not affect the overall findings and key messages of the report and are
limited to a small number of analyses relating to variations by age group.
We apologise for this error and any inconvenience caused.
If you would like to give feedback on this report or any other National End of Life Care
Intelligence Network output, please contact information@neolcin.nhs.uk
30