O-23 Patterns of acute hospital and specialist palliative care use among people with non-curative upper gastrointestinal cancer

Background and aim

Upper gastrointestinal (GI) cancers contribute to 16.7% of UK cancer deaths. These patients make high use of acute hospital services. The aim of this study is to determine the patterns of use of acute hospital and hospital palliative care services in patients with advanced upper GI cancer.

Methods

We conducted a secondary analysis of routinely-collected hospital data (2019–2022) for all patients with non-curative upper GI cancer in Hull University Teaching Hospitals NHS Trust. We captured all subsequent hospital admissions within the time period (except out-of-area acute hospital use).

Results

The total number with non-curative upper GI cancer was 960 (see table 1). 832 (86.7%) had at least one hospital admission over 4-years, with 1,239 admissions in total. 635/1239 (51.3%) admissions were unplanned via emergency department (ED), 283/1239 (22.9%) were unplanned not via ED, and 320/1239 (25.8%) were elective. Length of stay (LOS) varied by admission route; unplanned via ED, LOS = median 10 days (range 0–73); unplanned not via ED, LOS = median 10 days (range 0–48); elective, LOS = median 4 days (range 0–71). Among the 832 patients admitted at least once, we examined patterns of hospital re-admission in relation to hospital specialist palliative care (HSPC) referral, with: For the whole 4 years: 120 re-admissions among 229 patients referred to HSPC (rate 0.52 readmissions/patient/4 years) versus 884 re-admissions among 603 patients not referred to HSPC (rate 1.47 readmissions/patient/4 years). For last-year-of-life only: 38 re-admissions among 61 patients referred to HSPC (rate 0.62 readmissions/patient/year) versus 293 re-admissions among 170 patients not referred to HSPC (rate 1.72 readmissions/patient/year).

Discussion

Patients referred to hospital specialist palliative care were notably less likely to be re-admitted, although may be closer to death and/or have more complex needs (not adjusted for in this analysis). Nevertheless, this evidence supports early and more frequent referral to hospital specialist palliative care.