The higher the risk of developing end-of-life colon cancer the greater the overall increased risk of survival when radiation therapy is given at the recommended intervals some patients were found to have. In particular the risk was slightly higher in those generally considered to be at higher risk of developing end-stage disease.

The results published today in the Annals of Internal Medicine are effective and timely.

End-of-life care for men is currently neglected in Britain with little guidance for patients and doctors and few efforts made to integrate cancer screening into end-of-life care.

A majority of 1029 men who developed end-stage disease in Britain between 1995 and 2014 received radiation therapy and in most cases there was no follow-up care afterwards.

After 17 years all but one of these cases of colon cancer were found to have been successfully treated with radiation and there was no follow-up care at 52 years.

However 11 of the cases occurred in patients with a significantly higher risk of developing end-stage disease than those without so-called advanced end stage disease which would involve advanced cancer with high levels of evidence of treatment-resistance and resistance to therapy.

In this group the 5-year risk ratio (5-RR) for death or protracted suffering from a chronic condition was 80 per cent higher compared to that of patients in the general population.

This means the health system was underestimating the risk of end-stage disease experience compared to the general population.

The findings indicate that radiation therapy and end-of-life care should be integrated into end-of-life care with improved communication analysis of clinical and prognostic factors and possible cost effectiveness in co-payments.

Fixed charges may also be implemented.

In the UK uptake of radiation therapy and end-of-life care is up to 90 per cent and they remain above 90 per cent in Germany although more advanced technologies may allow for artificial intelligence (AI) to help better manage the end-of-life process.

Although early death and prolonged suffering may be acceptable once the end-stage disease is out of the picture there are few regulations in place and services have been unsure about the treatment options for a long time.

Dr Pal of the University of Melbourne said: Good quality end-of-life care is important for all patients but treatment interruption due to cancer treatment causes the greatest disruption of quality of life and has a particularly large impact for cancer patients and their carers. Previously there was only uncertainty around treatment beyond death but this study demonstrates the lack of guidance and intensive support for cancer survivors.

If end-of-life care is in evidence with survival rates above 80 per cent then this review should be a stopgap until such time as these remaining important outcomes are properly addressed. The public health view should be to provide a single clear common sense approach to achieving better end-of-life outcomes.

Dr Pal is a commended researcher who was supported by funding from the National Institute for Public Health Research (NIHR) through the Prayer Response Research (PRR) Program.