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Bowel Cancer: Postoperative deaths fall for fourth consecutive year, says national audit

December 17, 2012: Call to "break taboo that locks symptoms behind bathroom door" as emergency admissions continue to cause concern

The proportion of bowel cancer patients who die following major surgery has fallen for the fourth consecutive year, new figures from the National Bowel Cancer Audit show.

5.1 per cent of patients diagnosed in 2010-11 (the current audit year), had died 90 days on from their operation, compared to 6.4 per cent of patients diagnosed in 2007-08.

The audit shows that keyhole (laparoscopic) surgery rates rose in the same time period from 25 per cent to over 40 per cent. Keyhole surgery was found to be associated with both shorter hospital stay (six days, compared to nine days for open surgery patients) and a reduced risk of post-operative death (2.6 per cent for keyhole surgery versus 6.7 per cent for open surgery). However keyhole surgery is usually performed on fitter patients, with less advanced disease, who come into hospital for a planned operation.

Today's audit report, which looked at data for just over 29,000 bowel cancer patients diagnosed in 2010-11, was commissioned by the Healthcare Quality Improvement Partnership 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.

It also highlights that emergency admissions for bowel cancer continue to be a major cause of concern. Overall, 21.1 per cent of patients with bowel cancer were admitted as an emergency with severe and potentially life-threatening symptoms. Nearly one third of these admissions were not suitable for surgical intervention (29.5 per cent) and of those that had emergency surgery, more than one in 10 had died within 90 days of the emergency operation (11.9 per cent).

Through new data analysis, the audit today also highlights a delay in the closure of "temporary" stomas after operations to remove rectal (back-passage) cancer. Patients are commonly counselled that a "temporary" stoma after rectal cancer surgery (anterior resection) will be closed within six months of surgery. However today's new analysis (which links audit data to Hospital Episode Statistics (HES) information) shows 38 per cent of patients still had a "temporary" stoma 12 months after undergoing an anterior resection. Future work is required to determine if this delay is related to further treatments, such as postoperative chemotherapy, or a lack of operating time.

Nigel Scott, audit clinical lead and consultant colorectal surgeon at the Royal Preston Hospital, said: "The National Bowel Cancer Audit continues to make a contribution to understanding and improving the patient journey with bowel cancer. However, bowel cancer emergency admissions are a persistent and very significant health problem.

"Symptom awareness campaigns are useful to break down the taboos of bottoms and bowels that lock these symptoms behind the bathroom door. But emergency surgery continues to be the Cinderella of surgical practice in the UK.

"A recent survey of surgeons highlighted that the NHS pressures currently work against emergency cases with 55 per cent of surgeons describing inadequate emergency theatre access. Only 15 per cent of emergency surgeons have a comprehensive interventional radiology service out of hours and this deficiency has a major detrimental effect on the use of colonic stenting for the emergency colorectal cancer admission. These findings are also mirrored in a recently published report by the Department of Health and the Royal College of Surgeons."

Read the National Bowel Cancer Audit 2012 report

ENDS


Notes to editors

1. The Health and Social Care Information Centre (HSCIC), formerly the NHS Information Centre, is now known by its formal, legal name; reflecting its broader social care responsibilities. We are England's authoritative, central, independent source of health and social care information. We work with a wide range of health and social care providers nationwide to provide the facts and figures that help the NHS and social services run effectively. Our role is to collect data, analyse it and convert it into useful information which helps providers improve their services and supports academics, researchers, regulators and policymakers in their work. We also produce a wide range of statistical publications each year across a number of areas.

2. The Healthcare Quality Improvement Partnership (HQIP) is led by a consortium of the Academy of Medical Royal Colleges, the Royal College of Nursing and National Voices. Its aim is to promote quality improvement, and in particular to increase the impact that clinical audit has on healthcare quality in England and Wales. HQIP hosts the contract to manage and develop the National Clinical Audit and Patient Outcomes Programme (NCAPOP). Their purpose is to engage clinicians across England and Wales in systematic evaluation of their clinical practice against standards and to support and encourage improvement in the quality of treatment and care. The programme comprises more than 30 clinical audits that cover care provided to people with a wide range of medical, surgical and mental health conditions.

3. The Royal College of Surgeons of England is committed to enabling surgeons to achieve and maintain the highest standards of surgical practice and patient care. Registered charity number: 212808. For more information please visit http://www.rcseng.ac.uk/

4. The Association of Coloproctology of Great Britain and Ireland is a multi-disciplinary organisation whose membership, consisting of medical, nursing and associated healthcare professionals, treat most patients with bowel cancer. The bowel cancer audit was initially developed by the Association over ten years ago and is now one of the national cancer audits commissioned by HQIP.

5. Audit findings over 1000 in this press release have been rounded.

6. View the survey at http://www.asgbi.org.uk/en/members/asgbi_surveys.cfm

7. "The Higher Risk General Surgical Patient": http://www.rcseng.ac.uk/publications/docs/higher-risk-surgical-patient

8. For media enquires or to request an interview with a clinical lead about the audit, please contact the HSCIC press office at media@hscic.gov.uk or 0845 2576990

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