Inpatient admissions and outpatient appointments in the first year post cancer diagnosis: A population based study from England

1

Introduction

There are over 300,000 new cancers (excluding non-melanoma skin cancers (NMSC)) in England each year [ 1 ]. 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 [ 2 ] 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 [ 3 ], and to compare resource utilisation and costs of different institutions [ 4 ]; or to identify opportunities for process improvements and development of additional or alternative services [ 5 ]. There has however been no population-wide study of LOS for cancer diagnoses in England.

Reducing LOS improves patients’ well-being [ 5 ] and quality of care [ 6 ], and helps ease the financial burden faced by cancer patients [ 7 ]. 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 [ 5 ].

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 [ 8 ]. Similar work in Brazil focused on inpatient stays for major cancer sites only [ 9 ]; our work describes all hospital utilisation in diverse English registered cancers.