Why less cancer patients are dying in US hospitals than others
In 2010, 22.2 percent of cancer patients in the U.S. died in the hospital compared to 70 percent in the 1980s. It is the lowest rate of the countries in the study, which includes Belgium, Canada, England, Germany, the Netherlands and Norway.
The international Consortium for End-of-Life Research systematically examined patterns of care, healthcare utilization and expenditures in senior patients older than 65 who died from cancer in hospitals in 2010.
“The essential take-away from the study is that there is great variability across the nations in end-of-life practices, but we know now that we can reduce the intensity of care at the end of life in the U.S. and in other nations, and we know we need to move end-of-life care out of hospitals,” said University of Pennsylvania MD Justin Bekelman.
“We know that end-of-life care is expensive, intensive and not consistent with the wishes of our patients, and we also know that too many patients are still dying in the hospital in the U.S., but what we didn’t know is how the U.S. compares with other countries.”
In addition, the study also reveals American patients who do indeed pass away while in the hospital spend fewer days there during the final six months of their lives.
However, more than twice as many U.S. patients who pass away from cancer are admitted to the intensive care unit (ICU) and receive more chemotherapy in the final six months of their lives.
NHS staff face severe impact on mental health due to COVID
The decision to drop COVID-19 restrictions in England this month alarmed doctors in the National Health Service (NHS) while hospitalisations are on the rise. At the same time, hospitals have started cancelling operations again adding to the existing backlog of operations, which estimates say could take a year to clear.
Dr James Gilleen of the University of Roehampton and his Covida Project team are warning of the ongoing risks to the mental health of NHS staff, many of whom are traumatised from the first wave of infections. “As the UK continues to see COVID-19 infection numbers rise at a similarly alarming rate as those seen during the country’s second wave, it’s combined with a renewed strain on the NHS and its staff" he said.
The Covida Project is a digital tool created to assess the psychological impact of the COVID-19 pandemic on frontline workers including NHS staff, the police and carers.
“Healthcare workers are already exhausted and burnt-out; they are traumatised from their experiences of working during the pandemic. During the first wave in May 2020, a study from the Covida Project found an unprecedented quadrupling of the number of NHS staff with high levels of anxiety, depression and post-traumatic stress disorder (PTSD) compared to before Covid-19" Gilleen said.
"Having the most severe levels of these symptoms was statistically linked to four key factors - insufficient access or pressure to reuse Personal Protective Equipment (PPE), insufficient workplace preparation, insufficient training and communications, and a higher workload. Staff aren’t just anxious, depressed and traumatised from being over-worked – it is from feeling unsafe and at risk."
The Covida Project found that almost a third of healthcare workers reported moderate to severe levels of anxiety and depression. The number reporting very high symptoms was four times higher than before the pandemic.
Gilleen adds, “With COVID-19 restrictions now fully removed in England, NHS staff face the daunting triple-threat of rising Covid-19 hospitalisations, huge backlogs of medical operations to clear, and the added expectation of large increases in winter flu, which is already being seen even now in summer.
"These difficulties are present at a time when the NHS is already under-resourced, impacted by sickness and/or staff being ‘pinged’ to self-isolate through the government’s track and trace app, and staff continuing to fear the daily risk of infecting family and friends.
"Together these are considerable psychological burdens and create a perfect storm for the mental health and well-being of NHS staff."
Gilleen says there may be worse to come, especially if new, more transmissible variants develop. "Previous research after other pandemics such as SARS has shown that residual mental health symptoms like PTSD can continue for years, so the impact of repeated waves over the long-term will be potentially catastrophic for the mental health of NHS staff.
He has some clear recommendations to protect the wellbeing of frontline healthcare workers. “To protect the mental health of NHS staff they must feel they are less at risk or in danger, have access to the required level of PPE, not be continuously over-worked, with better staffing, more opportunities for rest and space to share their stress.
"Despite this and similar findings from other studies, still not enough is being done to protect NHS staff mental health and wellbeing and we fear it will continue to suffer in the months to come. With this comes the real risk that large numbers of staff will burn out or even quit the NHS.”