A new report has found that 67% (78,609) of colorectal cancer patients diagnosed between 1 April 2008 and 31 March 2011 survived for at least two years. Two year survival is 80% for patients who have major surgery and 43% if not, 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.
Nigel Scott, Consultant Colorectal Surgeon at Lancashire Teaching Hospitals Trust and Audit Clinical Lead 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.”
The data showed that:
- Across England and Wales the two year mortality for bowel cancer patients undergoing major surgery was 24%.
- Wales had a higher than expected adjusted two year mortality rate (27.5%). A factor in this may be the lack of detailed data available to further refine the estimate (mode of admission and coexisting illness).
- Wessex had the lowest adjusted two year mortality rate at 21.2%
- Across England and Wales, 66% 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%); Yorkshire and the Humber (76%); London Cancer Alliance (79%) and London Cancer Network (76%)
- Wessex had the lowest proportion of patients in hospital five days after surgery (54%)
- 90 day post-operative mortality has remained steady at 4.6% after major surgery for colorectal cancer, having fallen from 6.1% in 2008-09
- Emergency admission with colorectal cancer remains at 21% of all cases. Emergency major surgery is associated with a risk of death of 16% at 90 days.
- Keyhole (laparoscopic) surgery rates continue to increase, to around 45% of resections in 2012/13, up from 25% 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.