Worrying difference in bowel cancer rates

These findings from University of Leeds researchers, which come from a study funded by Cancer Research UK and Yorkshire Cancer Research, are published today in the journal Gut.

In the study, researchers looked at all patients who had major surgery to remove their bowel cancer over a nine year period (between 1998 and 2006) in the English NHS and examined the numbers who survived 30 days after their operation.

They found that overall, 6.7 per cent of patients (10,704) died within 30 days of their surgery – a proportion which is higher than other countries such as Scandinavia, Canada and the USA, where comparable figures range from 2.7 per cent (for rectal cancer only) to 5.7 per cent.

However, the researchers also found a reduction over time in the percentage of deaths occurring.  In 1998, almost 6.8 per cent of patients died within 30 days of their bowel cancer surgery, but this had declined to almost 5.8 per cent by 2006.

Deaths within 30 days following surgery in England were higher in certain groups including men, the elderly, people who were ‘worse off’, had advanced cancer, presented as emergencies, or those who also had other diseases.

And, despite taking into account these factors, there was also variation between NHS hospital trusts with three hospitals over the study period having significantly higher percentages of deaths within 30 days following surgery and one having far fewer deaths.

The National Cancer Intelligence Network has used this new methodology to examine the latest data from these five poorest performing trusts, as well as the three best trusts, in 2007-08. This preliminary data shows that all of the five trusts performed better from 2007-08. The results of all hospitals in England are being published online by the NCIN.

Professor Paul Finan, study author and Professor of Colorectal Surgery at the University of Leeds, said: “It’s very encouraging to see that overall the 30-day postoperative mortality rate is decreasing across the country. But, having adjusted for those factors that can affect post-operative mortality, it is a concern that there is significant variation between hospitals. 

“Understanding why this has occurred is a complex matter and is now a priority for the National Cancer Intelligence Network and the wider cancer community. It’s vital to learn from the Trusts with very low post-operative mortality so that we can identify and spread best practice across the NHS and so help to reduce post-operative mortality further.”

Dr Eva Morris, study author and Cancer Research UK Bobby Moore fellow at the University of Leeds (based at the Northern and Yorkshire Cancer Registry and Information Service), said: “This study examines the overall performance of the English NHS in managing surgically treated bowel cancer patients.  It shows that some patients will always be at a greater risk than others but, despite this, the service is improving.

“The study has only been made possible by using routine NHS data submitted by hospitals. The quality of these data may vary slightly between hospitals but they are the best available to gain a national picture of the quality of care.  Hospitals are paid on the basis of this information so it is in the interests of all that any inaccuracies are eliminated.”

For further information:

Paula Gould, University of Leeds press office: Tel 0113 343 8059, email [email protected]

The paper, Morris et al, Thirty-day post-operative mortality after colorectal cancer surgery in England, is published in Gut (2011); doi: 10.1136/Gut.2010.232181.

A map of all hospital trusts between 1998 and 2006, and the eight outlying trusts in 2007-08 can be found at: www.ncin.org.uk/colorectal