Data briefings

These data briefings are written for a general audience. They are short documents focusing on important measures in colorectal cancer care.

This work involves patient-level information collected by the NHS that has either been provided by, or derived from, patients as part of their care and support. The data is collated, maintained and quality assured by the National Cancer Registration and Analysis Service, which is part of Public Health England (PHE). Access to the data was facilitated by the PHE Office for Data Release.

30-day post-operative mortality after major surgery for colorectal cancer

Key Message:

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There is significant variation in the 30 day post operative mortality rate between Trusts ranging from 0% to 6.3%.

The characteristics of the individuals who died within 30 days of surgery are varied. Age, a history of pre existing chronic health conditions, a late or unknown stage tumour and those who were admitted to hospital as an emergency are all factors associated with 30 day post operative mortality.

Background

30-day post-operative mortality is defined as a death which happens within 30 days of a patient undergoing surgery. Surgery is the most common and effective treatment for colorectal cancer with 66% of patients diagnosed with colon cancer and 63% of patients diagnosed with rectal cancer undergoing surgery to remove their tumour.  Surgery carries a risk and it is important that patients are informed of the risks involved and how these risks can vary between individuals. 30-day post-operative mortality can also be used to look at individual NHS Trusts to investigate why variation between the Trusts might occur and what quality improvement measures could be implemented to improve outcomes. This study aimed to look for common characteristics among patients with colorectal cancer who died within 30 days of their surgery.

Results

The rate of post-operative mortality within 30-days of major surgery for colorectal cancer varied between the 146 Trusts that operated on patients. It ranged from 0% to 6.3%.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Conclusion

The rate of 30-day post operative mortality between English NHS Trusts is significantly varied. It is important to identify the reason for this variation to establish whether improvement measures can be implemented. Patients above the age of 80 years, those with a history of pre-existing health conditions, a late or unknown stage tumour and those who were admitted to hospital as an emergency all displayed higher rates of 30-day post operative mortality.

90-day post-operative mortality after major surgery for colorectal cancer

Key Message:

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There is significant variation in the 90 day post-operative mortality rate between Hospital Trusts ranging from 0% to 11%.

The characteristics of the individuals who died within 90 days of surgery are varied. Age, a history of pre-existing chronic health conditions, a late or unknown stage tumour and those who were admitted to hospital as an emergency are all factors associated with 90 day post-operative mortality.

Background

90-day post-operative mortality is defined as a death which happens within 90 days of a patient undergoing surgery. Surgery is the most common and effective treatment for colorectal cancer with 66% of patients diagnosed with colon cancer and 63% of patients diagnosed with rectal cancer undergoing surgery to remove their tumour.  Surgery carries a risk and it is important that patients are informed of the risks involved and how these risks can vary between individuals. 90-day post-operative mortality can also be used to look at individual NHS Trusts to investigate why variation between the Trusts might occur and what quality improvement measures could be implemented to improve outcomes. This study aimed to look for common characteristics among patients with colorectal cancer who died within 90 days of their surgery.

Results

The rate of post-operative mortality within 90-days of major surgery for colorectal cancer varied between the 146 MDTs. It ranged from 0% to 11.0%.

 

 

 

 

 

 

 

 

 

Conclusion

The rate of 90-day post operative mortality between English NHS Trusts is significantly varied. It is important to identify the reason for this variation to establish whether improvement measures can be implemented. Patients above the age of 80 years, those with a history of pre-existing health conditions, a late or unknown stage tumour and those who were admitted to hospital as an emergency all displayed higher rates of 90-day post operative mortality.

Deaths within a year of diagnosis of colorectal cancer

Key message:

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Colorectal cancer survival rates in England are lower than those in other European countries.
Over 70% of patients survived for at least a year after their diagnosis.
The majority of patients who died within a month of their diagnosis had been admitted to hospital as an emergency.

Background

When compared to other countries in Europe, the survival rates for colorectal cancer in England are poor. Previous research suggests that the reason for this is that more patients in England die sooner after their diagnosis.

In order to find out why survival rates are lower in comparison, it is important to understand what the factors are that are associated with early mortality and examine the characteristics of the bowel cancer patients.

This study looked at individuals in the English NHS who were diagnosed with bowel cancer between 2014 and 2015.

Results

72.3% of patients diagnosed with bowel cancer between 2014 – 2015 survived for at least a year from diagnosis. A total of 17,855 individuals died within the first year. Of these patients, 26.3% died within a month of their diagnosis 14.4% within 1 to 3 months and 59.3% within 3 to 12 months.

 

The number of patients who survived for longer than a year from the time of their diagnosis varied between Multi-Disciplinary Teams, ranging from 64.9% to 88.2%.

 

 

 

The majority of patients who died soon after diagnosis were aged 80 and over.

 

 

The majority of patients who died within a month of diagnosis had disease of unknown stage. For those who died between 1-12 months from diagnosis, stage IV cancer had been diagnosed.

 

Over half of the individuals who died within a year of diagnosis were not recorded as having received NHS surgery.

 

 

73.6% of individuals who died within a month of their diagnosis of colorectal cancer had been admitted as an emergency.

 

 

Conclusions

The results show that the majority of patients who died soon after a diagnosis of colorectal cancer were aged 80 and over and were admitted to hospital as an emergency. Patients were also more likely to have either a tumour of unknown or late stage cancer.  Increasing public awareness of the symptoms of bowel cancer could be a key factor in diagnosing patients earlier. This in turn could then lead to the number of deaths within a year of a diagnosis of colorectal cancer decreasing, and closing the gap between the rates in England and the rest of Europe.

Length of hospital stay after major surgical resection for colorectal cancer

Key Message:

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The average length of hospital stay for a patient after colorectal cancer surgery in England is 7 days.
There is a wide variation between Trusts in the number of patients with an ideal length of stay which should be addressed.

Background

Through the introduction of the Enhanced Recovery after Surgery (ERAS) pathway, effort is being made to try and cut the length of hospital stay for patients following major surgery, whilst also ensuring that they still receive effective treatment and high quality care.

This study looked at a patient’s length of stay following major surgical resection for a colorectal cancer between 2015 and 2016 in the English NHS. Patterns were then investigated to identify what factors might influence the length of stay of a patient following major surgery for colorectal cancer.

Results

The average length of stay in hospital for a patient is 7 days. The number of patients with a hospital stay of 5 days or less ranged from 0% to 75% across colorectal Multi-Disciplinary Teams in the English NHS Trusts.

 

 

 

The number of individuals who had a length of stay of 21 days and over increased with age.

 

 

Patients with higher levels of comorbidity were more likely to have a “prolonged” length of hospital stay.

 

 

Patients admitted to hospital as an emergency for their surgery were more likely to have an increased length of stay.

 

 

Conclusions

Despite the introduction of the Enhanced Recover after Surgery pathway, there is still huge variation between the NHS Trusts in a patients’ length of stay following major surgery for colorectal cancer. It is important to understand why this variation occurs so improvement measures can be made to enable Trusts to discharge patients within the ideal length of time. Discharging patients earlier not only decreases costs to the NHS, but it could also decrease the risk of patients developing hospital acquired infections.

Rectal cancer in old age

Key Message:

There is significant variation between NHS Trusts in the use of potentially curative treatment amongst patients over the age of 80.

The outcomes for patients over the age of 80 who received potentially curative treatment could be comparable to those of patients in the younger age brackets.

Background

More than 22% of rectal cancers are diagnosed in older patients. Older patients are defined as those aged 80 years and over. It is predicted that the proportion of the UK population considered to be old will double within the next 25 years, which means it is likely there will be a larger number of cancers being diagnosed in old and very old people. This has led to the treatment and outcomes of older patients being an important focus for policy makers.

The current treatment of older patients is controversial. Older patients are less likely to receive surgery, radiotherapy and chemotherapy than younger patients. It has been suggested that under treating older patients could be a reason why England has worse rectal cancer survival rates that other European countries. On the other hand some studies have suggested that reduced treatment on older patients is acceptable as they have worse outcomes than younger patients.

The study examined the use of different treatment for rectal cancer and the associated outcomes.

Results

 

There is significant variation between NHS Trusts in the proportion of patients over the age of 80 who underwent a major surgical resection.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Conclusion

The study found that patients over the age of 80 are less likely to receive potentially curative treatment for rectal cancer than younger patients, which is not fully explained by taking into account factors such as comorbidity or stage of the disease. It also found that although more risks can be involved in the radical treatment of older people, the outcomes can be comparable.

The results of this study highlights that more work need to be done to understand the variation between hospital Trusts in the management of older patients and that action must be taken to ensure that there is not an inappropriate emphasis on age when the decision is made on whether potentially curative treatment is offered.