National bowel cancer audit shows continued progress

In collaboration with Adfero

Bowel cancer care continues to improve in England and Wales, according to the latest annual report from the national audit of bowel cancer.

The report, which was published yesterday on behalf of the Association of Coloproctology of Great Britain and Ireland, is based on information provided by all but three trusts for the one-year period from August 2008 to July 2009.

It includes data on 23,769 patients who were diagnosed with colorectal cancer during the audit period, including about 60 per cent with bowel cancer and one-third with rectal cancer.

It shows that post-operative death rates following major surgery have fallen to 2.6 per cent.

However, the post-operative death rate in urgent and emergency cases is 7.7 per cent, highlighting the importance of early treatment.

Keyhole surgery is now becoming more common and accounted for 25 per cent of procedures during the one-year period.

Overall, 75 per cent of bowel cancer patients underwent some form of surgical procedure, with 60 per cent having major surgery and 23 per cent requiring urgent or emergency surgery.

The report also shows that the proportion of cases discussed by a multi-disciplinary team has increased, from 83.7 per cent in the 2009 report to 95 per cent in the latest audit.

The proportion of patients seen by a nurse specialist has also risen, from 51.2 per cent to 80 per cent.

Professor Paul Finan, the clinical lead for the audit, said: "The national bowel cancer audit has clearly been embraced by almost all trusts within England and Wales and the information obtained should have a direct effect on the management of patients with this common cancer.

"It is encouraging to see a continued fall in post-operative mortality, but the increased mortality observed when operating in the urgent or emergency situation should prompt particular attention to cases that present acutely."

The professor added that the national bowel cancer screening programme and better public awareness of the symptoms of bowel cancer should lead to improved outcomes for the disease.

John Black, president of the Royal College of Surgeons, said: "This study makes it clear just how important it is for patients to receive an early diagnosis and a planned admission to hospital is in treating this cancer - the screening programme currently being rolled out across the country should pick up a greater proportion of cancers at an early stage.

"The continued improvements in mortality and uptake of key-hole surgery techniques show the commitment of surgeons working in this field to improve care."

Dr Lesley Walker, Cancer Research UK's director of cancer information, said: "This report shows that the UK has led the world in monitoring bowel cancer patients' quality of care. But it's a great pity that the conclusions of the report are inevitably limited, with information on three in ten patients missing. Complete, good quality data are crucial if we are to accurately measure the success of treatment.

"This just shows that we mustn't be complacent - although participation by hospital trusts and networks is improving, some of our biggest hospitals are failing to submit complete data. Information on cancer staging is far from complete, and information on post-surgical complications - which is crucial to assess our surgeons' competence - is incredibly poor.

"We look forward to seeing continued improvement in data quality and completeness in future audits, which will no doubt translate into further progress in bowel cancer care."