Audit reveals improvement in bowel cancer surgery care, but gaps remain

In collaboration with the Press Association

There have been improvements in the care of bowel cancer patients in England and Wales, although more still needs to be done if national recommendations are to be met.

The latest annual report from the National Bowel Cancer Audit - which analysed the care provided to 41,000 patients in England and Wales between April 2006 and July 2008 - found that post-operative mortality has decreased from around seven per cent of patients in 2001 to 4.5 per cent.

Paul Finan, consultant coloproctologist and clinical lead of the National Bowel Cancer Audit, said: "This report demonstrates that the outlook for bowel cancer patients has never been better and standards of care are moving in the right direction.

"But it also provides hints to where we need to progress more quickly towards the very best standards and save more lives in the future."

The National Institute for Health and Clinical Excellence (NICE) recommends that all patients should have their case discussed by a multidisciplinary team including radiologists, pathologists, anaesthetists and surgeons, rather than a single clinician making decisions about the best course of treatment.

In the latest audit, the figures show that 84 per cent of cases were discussed by a multidisciplinary team in 2007-08 - up from 80 per cent in 2006-07 but still short of the 100 per cent target.

Specialist nursing is becoming more common, with over half of patients receiving advice and support from a specialist bowel cancer nurse in 2007-08 compared with 41 per cent in 2006-07.

The true figure may be higher than reported as the audit notes that data submission for this measure was poor.

Again, however, NICE recommends that all patients should have access to this level of nursing expertise, indicating that there is still progress to be made.

Access to advanced diagnostic imaging such as magnetic resonance has improved (from 41 to 51 per cent), as has access to computerised tomography scans (from 55 to 61 per cent).

But a quarter of patients are not getting the stage of their disease recorded, which means that they may not receive the best possible choice of treatment.

The audit also highlighted wide variation in the way in which different cancer networks treat bowel cancer, again showing room for improvement.

Mr Finan commented: "Every patient should have their case and treatments discussed by a full team of experts and have the benefit of advice and support of a specialist nurse.

"There are now many different approaches to treating this disease and picking the best one for each patient needs universal access to diagnostic scanning so the stage of the disease can be assessed and the most well-informed decisions made."

Tim Straughan, chief executive of the NHS Information Centre, welcomed improved participation in the audit, but conceded that the data is still incomplete.

"Trusts and cancer networks are falling below national guidance in some areas according to this audit, which could in reality be due to poor data completeness rather than inadequate care," he pointed out.

"It is vital submissions improve to provide a clear picture of the quality of care experienced by bowel cancer patients."

Sarah Woolnough, Cancer Research UK's head of policy, said: "The National Bowel Cancer Audit is very helpful, although in future we need better data reporting for the findings to be more meaningful. While progress is being made we still need to make it faster in key areas.

"Cancer Research UK believes that all patients should have: their case discussed by a multi-disciplinary team, support and advice from a specialist nurse and the stage of their disease recorded.

"We also need to understand more about the variation among trusts in treating bowel cancer patients. Some of the variation is likely to be due to different reporting of data, but we want to ensure all trusts are offering bowel cancer patients the best possible treatment and care."