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80 per cent two year survival rate for bowel cancer patients who undergo major surgery

December 15, 2014: 67 per cent (78,609) of colorectal cancer patients diagnosed between 1 April 2008 and 31 March 2011 survived for at least two years, according to a report published today.

*Regional information is available from this audit

Two year survival is 80 per cent for patients who have major surgery6 and 43 per cent if not 7, according to the National Bowel Cancer Audit, published today by the Health and Social Care Information Centre.

There were variations in both two year mortality rates and length of hospital stay across Strategic Clinical Networks (SCN). The estimates are not adjusted for patient case mix and differences could be caused by differences in patient groups and data quality.

The data showed that:

  • Across England and Wales the two year mortality for bowel cancer patients undergoing major surgery was 24 per cent.
  • Wales had a higher than expected adjusted two year mortality rate (27.5 per cent). A factor in this may be the lack of detailed data available to further refine the estimate (mode of admission and coexisting illness).8
  • Wessex had the lowest adjusted two year mortality rate at 21.2 per cent
  • Across England and Wales, 66 per cent of colon cancer patients and 80 per cent of rectal cancer patients are still in hospital five days after resection.
  • The following SCNs had the highest proportion of patients in hospital five days after surgery - Greater Manchester, Lancashire and South Cumbria (78 per cent); Yorkshire and the Humber (76 per cent); London Cancer Alliance (79 per cent) and London Cancer Network (76 per cent)5
  • Wessex had the lowest proportion of patients in hospital five days after surgery (54 per cent)5
  • 90 day post-operative mortality has remained steady at 4.6 per cent after major surgery for colorectal cancer, having fallen from 6.1 per cent in 2008-09
  • Emergency admission with colorectal cancer remains at 21 per cent of all cases. Emergency major surgery is associated with a risk of death of 16 per cent at 90 days.
  • Keyhole (laparoscopic) surgery rates continue to increase, to around 45 per cent of resections in 2012/13, up from 25 per cent in 2008/09.

The audit report, which looked at data for almost 32,000 bowel cancer patients diagnosed in 2012-13, was commissioned by the Healthcare Quality Improvement Partnership as part of the National Clinical Audit Programme, and developed by the Health and Social Care Information Centre, the Association of Coloproctology of Great Britain and Ireland and the Royal College of Surgeons of England.

Consultant Colorectal Surgeon at Lancashire Teaching Hospitals Trust and Audit Clinical Lead Nigel Scott said: "The National Bowel Cancer Audit continues to make a contribution to understanding and improving the patient journey for bowel cancer.

"Bowel cancer treatment requires a multi-disciplinary team approach to successfully manage and treat patients. It is a great credit to the hospital teams of surgeons, nurses, oncologists, radiologists, pathologists and many other professionals that 80 per cent of resected cancer patients are surviving to two years.

"Variation in outcome between health units offers a possible insight into how practice might influence outcomes. For example, the substantial regional variation in the percentage of patients still in hospital five days after resection could have significant consequences for hospital expenditure in the NHS.

"There are many potential explanations for variation in two year mortality, including differences in patient characteristics, differences in the completeness and accuracy of data submitted, and differences in the quality of care for people with colorectal cancer, both before and after surgery.  We will investigate these potential causes in further detail in next year's National Bowel Cancer Audit."

ENDS



Notes to editors

1. The Health and Social Care Information Centre (HSCIC) was established on April 1 2013 as an Executive Non Departmental Public Body (ENDPB). The trusted source of authoritative data and information relating to health and care, HSCIC plays a fundamental role in driving better care, better services and better outcomes for patients. It supports the delivery of IT infrastructure, information systems and standards to ensure information flows efficiently and securely across the health and social care system to improve patient outcomes. Its work includes publishing more than 130 statistical publications annually; providing a range of specialist data services; managing informatics projects and programmes and developing and assuring national systems against appropriate contractual, clinical safety and information standards. www.hscic.gov.uk

2. About HQIP, the National Clinical Audit Programme and how it is funded:
The Healthcare Quality Improvement Partnership (HQIP) is led by a consortium of the Academy of Medical Royal Colleges, the Royal College of Nursing and National Voices. Its aim is to promote quality improvement, and in particular to increase the impact that clinical audit has on healthcare quality in England and Wales. HQIP holds the contract to manage and develop the National Clinical Audit Programme, comprising more than 30 clinical audits that cover care provided to people with a wide range of medical, surgical and mental health conditions. The programme is funded by NHS England, the Welsh Government and, with some individual audits, also funded by the Health Department of the Scottish Government, DHSSPS Northern Ireland and the Channel Islands. www.hqip.org.uk

3. The Royal College of Surgeons of England is committed to enabling surgeons to achieve and maintain the highest standards of surgical practice and patient care. Registered charity number: 212808. For more information please visit www.rcseng.ac.uk

4. The Association of Coloproctology of Great Britain and Ireland is a multi-disciplinary organisation whose membership, consisting of medical, nursing and associated healthcare professionals, treat most patients with bowel cancer. The bowel cancer audit was initially developed by the Association over ten years ago and is now one of the national cancer audits commissioned by HQIP.

5. Audit findings over 1000 in this press release have been rounded. Percentages for proportion of patients in hospital five days after surgery has been rounded to the nearest whole number.

6. Major surgery refers to a major resection for bowel cancer. This includes the following procedures:

Right Hemicolectomy; Transverse Colectomy; Left Hemicolectomy; Sigmoid colectomy; Total Colectomy; Anterior Resection; Abdomino-Perineal Excision of the Rectum (APER)/Exenteration of Pelvis; Hartmann's procedure.

7. There are many reasons why patients may not undergo major surgery to remove their cancer, including: some early stage cancers can be removed by a minor procedure; some patients have such advanced cancer that they are unlikely to benefit from major surgery; and some patients are too frail to withstand major surgery.

8. The risk-adjusted estimate for Wales may be high partly because the mode of admission and the number of comorbidities was not available for Welsh patients, as PEDW (Patient Episode Database for Wales) data were not available or due to differences in socio-economic differences that we cannot adjust for.

9. For media enquiries to the HSCIC please call 0300 30 33 888 or email media@hscic.gov.uk

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