When discussing medical options, patients with poor prognosis cancer (PPC) palliative anti-cancer treatment may not always be the best option due to co-morbidities, frailty or patient preferences. When treatment is the best option a patient may be offered “best supportive care” (BSC), a support system which is sometimes not properly clinically defined and shows significant variations in practice and patient experience in Scotland. Without a complete understanding of the demographic and clinical implications that BSC and palliative care can lead to, honest discussions around treatment options are particularly challenging.

Patients are at increased risk of over-medicalisation (Ho T.H. et al, 2011 and Lightbody C.J. et al, 2018) and recent data from South East Scotland have demonstrated that people in their last phase of life from disadvantaged communities are more likely to experience crisis admissions to hospital (Murray S. et al, in write-up). There is a significant lack of linked data for PPC and recently published predictions show that palliative care needs can grow by up to 20% in 2040 (Anne Finucane et al, 2021).

A data linkage analysis funded by the Health foundation was recently conducted by Katharina Diernberger et al, aiming to investigate the NHS admission and economical patterns of the last year of life for cancer patients in Scotland. Admission rates were found to increase during the last month of life, particularly for haematological and lung cancers. Admission costs decrease with age, and were mostly driven by unscheduled admissions. Although this study brings valuable information in understanding admission patterns for patients affected by cancers in Scotland, additional work is necessary to better establish the current value-based care received by these patients and how it can be improved. It is in this context than I-Qual-PPC was designed.