title: Place of death in children and young people with cancer and implications for end of life care: a population-based study in England, 1993-2014.
abstract: Efforts to improve end of life care (EoLC) have made tangible impacts on care in adults, including enabling more people to die at their preferred place of death (PoD), usually home or hospices. Little is known how the PoD in children and young people (CYP, ≤24 years) has changed over time, especially in the context of a series of national initiatives for EoLC improvement since the late 1990s. To inform evidence-based policy-making and service development, we evaluated the national trends of PoD and the associated factors in CYP who died with cancer.
  
  
  
  Population-based observational study in the National Health Service (NHS) England, 1993-2014. All non-accidental CYP deaths with cancer (N = 12,774) were extracted from the death registration database of the Office for National Statistics (ONS).
  
  
  
  Hospital deaths reduced from >50 to 45 %, hospice deaths were rare but more than doubled from 6 % in 1993-2000 to 13 % in 2005-2014, and home deaths fluctuated at around 40 %. Those aged 0-19 years were more likely to die at home than young adults (adjusted proportion ratio (PRs): 1.23-1.62); haematological cancer patients or those with 2+ comorbid conditions had higher chances of hospital death (PRs for home: 0.18-0.75, hospice: 0.04-0.37); deprivation was associated with a reduced chance of home death (PRs: 0.76-0.84). The residential region affected hospice but not home deaths. The variations of PoD by cause of death, comorbid conditions and deprivation slightly decreased with time.
  
  
  
  Hospitals and home were the main EoLC settings for CYP with cancer. Home death rates barely changed in the past two decades; deaths in hospitals remained the most common but slightly shifted towards hospices. CYP with haematological malignancy or with comorbid conditions had persistently high hospital deaths; these cases had an even lower chance of deaths in hospices (50 %) than at home. There were deprivation- and area-related inequalities in PoD which may need service- and/or policy-level intervention. The findings highlight a need for CYP specific initiatives to enhance EoLC support and capacities both at home and in hospices.
authors.affiliation: King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, Bessemer Road, Denmark Hill, London, SE5 9PJ, UK. wei.gao@kcl.ac.uk.
authors.forename: Wei
authors.identifier: 0000-0001-9798-6053
authors.initials: W
authors.lastname: Gao
authors.affiliation: Public Health England, Knowledge & Intelligence Team (South West), Grosvenor House, 149 Whiteladies Road, Bristol, BS8 2RA, UK.
authors.forename: Julia
authors.initials: J
authors.lastname: Verne
authors.affiliation: King's College London, Division of Health and Social Care Research, Addison House, Guy's Campus, London, SE1 1UL, UK.
authors.forename: Janet
authors.initials: J
authors.lastname: Peacock
authors.affiliation: Public Health England, Childhood Cancer, 4150 Chancellor Court, Oxford Business Park South, Oxford, OX4 2GX, UK.
authors.forename: Charles
authors.initials: C
authors.lastname: Stiller
authors.affiliation: Office for National Statistics, Life Events and Population Sources Division, Cardiff Road, Newport, Wales, NP10 8XG, UK.
authors.forename: Claudia
authors.initials: C
authors.lastname: Wells
authors.affiliation: King's College London, School of Medicine, Division of Asthma, Allergy and Lung Biology, Denmark Hill, London, SE5 9RS, UK.
authors.forename: Anne
authors.initials: A
authors.lastname: Greenough
authors.affiliation: King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, Bessemer Road, Denmark Hill, London, SE5 9PJ, UK.
authors.forename: Irene J
authors.initials: IJ
authors.lastname: Higginson
mesh_terms: D000293:Adolescent; D002173:Cancer Care Facilities; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D004739:England / Q000453:epidemiology; D005163:Factor Analysis, Statistical; D005260:Female; D049673:History, 20th Century; D049674:History, 21st Century; D006699:Home Care Services; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009369:Neoplasms / Q000453:epidemiology* / Q000266:history; D010166:Palliative Care; D011159:Population Surveillance; D013727:Terminal Care / Q000379:methods / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Cancer; Children and young people; End of life care; Inequality; Palliative care; Place of death