An English national record-level dataset has been created.
Patients spend an average of 25 days in hospital in the first year after diagnosis.
Younger and haematology patients require significantly more time in hospital.
Deprivation, region and sex have small impacts on length of stay.
End-of-life patients experience high hospital utilisation.
Time spent in hospital (length of stay) is an important component of patient experience and the financial cost of cancer care. This study documents the length of stay across English cancer diagnoses at a national level and reports on variation by patient demographics and tumour characteristics.
Data on all diagnoses of malignant neoplasms from the English National Cancer Registration and Analysis Service for 252,202 patients first diagnosed in 2015 was linked with NHS Digital’s Admitted Patient Care and Outpatient Hospital Episode Statistics datasets to quantify length of stay within one year following diagnosis. Length of stay was modelled using linear regression adjusted for sex, age, tumour type, stage, time spent alive during the study period, vital status at end of study period, region, deprivation and ethnicity.
Patients spend a mean of 25 days (median = 17 days; IQR = 8–34 days) in hospital in their first year. Tumour type, stage, age and vital status corrections had the strongest effects in the model adjusting for other independent variables. Younger patients tended towards longer stays.
Length of stay varies among patients by tumour type, age and stage. Estimating future health service demands should account for changes in incident tumour characteristics.
There are over 300,000 new cancers (excluding non-melanoma skin cancers (NMSC)) in England each year [ ]. English incidence is predicted to increase to around 437,700 cases annually by 2035, with an aging and growing population and shifts in disease type [ ] and stage. We need to prepare for the changing needs of this population by understanding this increasing burden on patients and healthcare services.
Length of stay (LOS) in hospital is one appropriate metric, as an outcome measure for quality of care [ ], and to compare resource utilisation and costs of different institutions [ ]; or to identify opportunities for process improvements and development of additional or alternative services [ ]. There has however been no population-wide study of LOS for cancer diagnoses in England.
Reducing LOS improves patients’ well-being [ ] and quality of care [ ], and helps ease the financial burden faced by cancer patients [ ]. Additionally, reducing LOS benefits the hospital system by releasing hospital bed capacity, improving flow through the system, in turn improving the working and care environment [ ].
In this study we aim to describe and model factors affecting LOS in the year after diagnosis. We create a population dataset quantifying total cancer-related LOS in days in the year following diagnosis for a cohort of cancer patients diagnosed with malignant cancer in England in 2015. We model LOS variation over different cancer and patient characteristics. We also distinguish end-of-life patients, defined as those who die within a year of their diagnosis, as these patients are known to require more hospital treatment [ ]. Similar work in Brazil focused on inpatient stays for major cancer sites only [ ]; our work describes all hospital utilisation in diverse English registered cancers.