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Evaluating and improving care

Cancer

Palliative care for people affected by cancer remains a core priority. Every year, around 8 million people die from cancer worldwide and the global number of cancer deaths is projected to increase.

Our programme of work on evaluating and improving care in cancer consolidates and builds on work across all themes including; preferences and priorities for care, assessment of symptoms and measurement of appropriate outcomes. Our goal is to improve the treatments and services available to people affected by cancer. For example, we have assessed new and emerging models of care, including day care (see Higginson et al, Supportive Care Cancer 2010;18(5): 627-37) and dignity therapy for cancer patients (Hall, S et al, BMJ Support Palliat Care 2011; 1:315-321), both studies using experimental or quasi-experimental designs.

In addition, we have evaluated, using a population-based design, the effects of the UK national end-of-life care programme on place of death in cancer. The programme appears to have enabled more people to die in their preferred place of death (Gao et al, PLoS Med 2013; 10(3):E17001410). This last analysis was completed as part of the GUIDECare project which sought to describe the variations in place of death and the factors that affect these across England. Also, the QUALYCare project is studying the quality of care provided to people affected by cancer in their last stages of life. It was carried out across London with 618 people giving us their views on care. Results have been presented to policy makers and local healthcare teams and are in the process of being submitted to journals.

In addition, as a link to the symptom-led research theme, we have work studying the treatment of pain during the last 3 months of life for people who died from 5 common cancers. Our research found that older people were more likely to miss out on appropriate analgesia (Higginson and Gao, J Clin Oncol 2012; 30(35): 4373-9).

Our future research in cancer will link with the C-CHANGE programme- studying the cost and complexity of care, our QUALYCARE study- where more results of the quality of care will soon become available, our research in Africa- where we are testing new palliative care services and our work on outcomes measurement- rolling out measures of outcome into practice. Our work on breathlessness is also highly relevant for people affected by cancer. For example, we have studied the needs of caregivers who are supporting people with breathlessness and we have evaluated a new service for people severely affected by breathlessness, caring for people with cancer and respiratory conditions.

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