Improving picture of overall care for bowel cancer patients

30 November 2011

National Bowel Cancer Audit release

The overall picture of care for bowel cancer patients in England and Wales continues to improve year on year with improving mortality rates for elective operations and greater use of advanced keyhole surgery, according to the 2011 annual report from the National Bowel Cancer Audit.

However the report notes that urgent and emergency surgery continues to carry a much greater risk of death compared to elective and scheduled procedures.

Read the full report here >>

Achievement levels continue to rise against key care measures; such as the percentage of patients who survive following elective and scheduled surgery and the percentage having less invasive forms of surgery.

The audit is commissioned by the Healthcare Quality Improvement Partnership on behalf of the Department of Health and published by the NHS Information Centre on behalf of the Association of Coloproctology of Great Britain and Ireland.

Among its key findings for the 12 months to July 2010, the report shows:

• Key-hole (laparoscopic) procedures, which are less invasive, are becoming more widely used and took place for 30 per cent of cases compared to 25 per cent in the previous 12 month period. This reflects a national training programme that has been underway in recent years to update the skills of colorectal surgeons.

• Overall post-operative mortality (death from any cause within 30 days of surgery) fell to 3.7 per cent overall, compared to 4.0 per cent in the previous 12 month period.

The percentage of deaths within 30 days specifically for elective and scheduled surgery both fell from 2.6 per cent to 2.4 per cent in the previous 12 month period.

However urgent and emergency surgery continues to carry a higher mortality rate at 6 and 11.2 per cent respectively, similar to the results contained in the previous annual report (6 per cent and 10 per cent respectively). This illustrates the need for earlier diagnosis and prompt and senior involvement with acute cases, particularly those requiring emergency or urgent surgery.

• Considering two of the main types of bowel cancer - colon and rectal cancer - the report found a higher death rate among colon cancer patients within 30 days of major surgery (4.2 per cent) compared to rectal cancer patients (2.5 per cent). This reflects the observation that colonic cancer presents more frequently as an acute case.

• Rectal cancer patients are less likely to have a major resection or undergo urgent or emergency surgery compared to colon patients. This is partly due to patients with rectal cancer presenting with earlier stage disease, less often acutely, and for both early and late disease there are treatment options other than major resection.

Professor Paul Finan, clinical lead for the audit said: "Changes in surgical techniques, use of state of the art imaging techniques, and the further reduction in 30-day post-operative mortality are to be welcomed.  However, late presentation as an acute case remains an issue and contributes significantly to the overall mortality figure. These patients would benefit if consultants led their care from the moment they enter the hospital.

"Late presentation of cases is an area of bowel cancer care that requires urgent attention both in primary and secondary care.  There needs to be an increased awareness of the symptoms of bowel cancer in the general population, along with implementation of modern management protocols for those patients presenting acutely."

Today's report is based on, for the first time, submissions from 100 per cent of trusts, and reports on the management of over 28,000 cases of bowel cancer during the 12 month period ending July 2010.

Case ascertainment (the percentage of cases that are submitted to the audit for analysis) also continues to improve, with an estimated 89 per cent and 97 per cent of cases from English and Welsh trusts respectively submitted.

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