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Many cancer patients ‘spending final hours in pain’

  • 6 Comments

Nearly one in every 10 people who died with cancer in England in 2014 spent the last 48 hours of their lives without adequate pain relief, according to data analysis by a charity.

The findings equate to more than 12,500 people spending their last days in pain, said Macmillan Cancer Support, which looked at latest results from the National Survey of Bereaved People.

“In the 21st century people should not be spending their final hours in pain in this country because the support is not there”

Lynda Thomas

Separate analysis by Macmillan, based on Office for National Statistics data, also found that cancer patients who received inadequate pain relief at home were twice as likely to die somewhere they did not want to, compared with those who received complete pain relief.

Previous research by the charity has shown that 73% of people with cancer would prefer to die at home, while recent figures from the ONS suggested only 30% were able to do so.

Macmillan said it was concerned that a lack of support at home, including pain relief, meant people with cancer at the end of life did not have enough choice over where they would like to be cared for and many are spending their final days in oversubscribed hospital beds against their wishes.

It urged the government to fix what it described as a “dismal” variation in the quality of end of life care, by funding improvements recommended in a major independent review of choice at the end of life published in February 2015.

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Lynda Thomas, chief executive of Macmillan Cancer Support, said: “Quite simply, in the 21st century people should not be spending their final hours in pain in this country because the support is not there.

“The review of choice at the end of life published last year set out a comprehensive set of recommendations that would help improve the end of life care in England. The government must fund and implement the recommendations of the review.”

Recommendations from the independent review of choice at the end of life included providing access to 24/7 nursing, a record of a person’s preferences and fast and free access to social care.

Macmillan’s new analysis found patients who received good or excellent out-of-hours care were 55% more likely to die in their preferred place, compared with those who had poor out-of-hours care.

“Urgent improvements to the availability of high-quality community care and 24/7 palliative care are needed”

Dee Sissons

Dee Sissons, director of nursing at fellow charity Marie Curie, said: “Lack of anticipatory prescribing – which ensures medicines are readily available, and little support out of hours, are issues that need tackling.

“It is also essential that staff have the right training around medicine management. It is possible for pain to be managed at home when people have the right support in place,” she said.

She added: “Urgent improvements to the availability of high-quality community care and 24/7 palliative care are needed to ensure people can die at home in comfort and with dignity.” 

  • 6 Comments

Readers' comments (6)

  • michael stone

    Unacceptable ! I say again, this isn't an acceptable situation, even if I am aware of some of the operational complexities (and, in fact, 'absurdities') which can lead to it happening.

    Not only do patients suffer that pain, but family remember it !

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  • michael stone

    Elaborating on my earlier comment.

    I am NOT suggesting that patients 'should never die in pain'.

    I'm saying - and I'll stick to patients who are dying and also mentally capable, because it takes too long to work this one through if patients are not mentally capable [at the time of the pain-relief request] - that if a dying patient asks for more pain relief, having had any associated risks explained, then it should be quickly provided. I see that as the patient's decision (especially, the decision about whether the risks associated with greater pain relief are acceptable).

    I am 100% NOT saying that 'clinicians can decide to administer pain relief and/or sedation to patients, WITHOUT GETTING PATIENT CONSENT'.

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  • Heartbreaking reading when you are a parent of a 25 year old cancer patient.

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  • some nurses are bit reluctant or lack confidence to use morphine based analgesia and stronger analgesics because of the side effects. We need to proactively educate and coach nurses to do better as it really is our responsibility to help people on there journey to be as pain free as possible emotionally and physically as well as spiritually

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  • I don't think you'll find that every cancer patient who dies in hospital is pain free.

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  • michael stone

    '... even if I am aware of some of the operational complexities ...' (from my first comment)

    One of them is indeed 'some nurses are bit reluctant or lack confidence to use morphine based analgesia and stronger analgesics because of the side effects.' as pointed out by anonymous 15 FEBRUARY, 2016 4:45 PM. Which is where we need clarity about whether the patient decides whether to accept any risks associated with a treatment, and the clinicians merely describe the risks to the patient - this is one of many issues, where at the moment 'things are very muddled' [and where we need clarity, before we can make progress].

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