Comparison of treatment and outcome information between a clinical trial and the National Cancer Data Repository

Morris, Eva; Jordan, Courtney; Thomas, James; Cooper, Matthew; Thorpe, Helen; Cameron, David; Forman, David; Jayne, David; Quirke, Philip

doi:10.1002/bjs.7295

Cited by 25 publications

(12 citation statements)

References 15 publications

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“…The increased trend for laparoscopic surgery has been demonstrated in other studies9, 10, but they examined only operations recorded as being completed laparoscopically and the coding of such procedures is often inaccurate in routine data sets4. In the present study the total number of operations attempted laparoscopically was calculated by including all procedures coded as laparoscopically converted.…”

Section: Discussionmentioning

confidence: 93%

“…Laparoscopic surgery can be challenging technically and associated with a long learning curve1–3. Although randomized trials provide evidence, their results may not always be directly transferable to the general population1, 4. Monitoring the introduction and outcomes of laparoscopic colorectal cancer surgery ensures that patients receive quality care in a cost‐effective manner.…”

Section: Introductionmentioning

confidence: 99%

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Population-based study of laparoscopic colorectal cancer surgery 2006–2008

Taylor

Thomas

Whitehouse

et al. 2013

British Journal of Surgery

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BackgroundClinical guidelines recommend that, where clinically appropriate, laparoscopic tumour resections should be available for patients with colorectal cancer. This study aimed to examine the introduction of laparoscopic surgery in the English National Health Service.MethodsData were extracted from the National Cancer Data Repository on all patients who underwent major resection for a primary colorectal cancer diagnosed between 2006 and 2008. Laparoscopic procedures were identified from codes in the Hospital Episode Statistics and National Bowel Cancer Audit Project data in the resource. Trends in the use of laparoscopic surgery and its influence on outcomes were examined.ResultsOf 58 135 resections undertaken over the study period, 10 955 (18·8 per cent) were attempted laparoscopically. This increased from 10·0 (95 per cent confidence interval (c.i.) 8·1 to 12·0) per cent in 2006 to 28·4 (25·4 to 31·4) per cent in 2008. Laparoscopic surgery was used less in patients with advanced disease (modified Dukes' stage ‘D’ versus A: odds ratio (OR) 0·45, 95 per cent c.i. 0·40 to 0·50), rectal tumours (OR 0·71, 0·67 to 0·75), those with more co-morbidity (Charlson score 3 or more versus 0: OR 0·69, 0·58 to 0·82) or presenting as an emergency (OR 0·15, 0·13 to 0·17). A total of 1652 laparoscopic procedures (15·1 per cent) were converted to open surgery. Conversion was more likely in advanced disease (modified Dukes' stage ‘D’ versus A: OR 1·56, 1·20 to 2·03), rectal tumours (OR 1·29, 1·14 to 1·46) and emergencies (OR 2·06, 1·54 to 2·76). Length of hospital stay (OR 0·65, 0·64 to 0·66), 30-day postoperative mortality (OR 0·55, 0·48 to 0·64) and risk of death within 1 year (hazard ratio 0·60, 0·55 to 0·65) were reduced in the laparoscopic group.ConclusionLaparoscopic surgery was used more frequently in low-risk patients. Copyright © 2012 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

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Section: Discussionmentioning

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Population-based study of laparoscopic colorectal cancer surgery 2006–2008

Taylor

Thomas

Whitehouse

et al. 2013

British Journal of Surgery

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“…A recent study, however, identified colorectal cancer patients enrolled in a randomised trial within the NCDR and found excellent agreement in the information recorded in both datasets with regard to both treatment and outcomes 30. This demonstrated that the data within the NCDR were sufficient to monitor 30-day postoperative mortality across the country.…”

Section: Discussionmentioning

confidence: 94%

Thirty-day postoperative mortality after colorectal cancer surgery in England

Morris

Taylor

Thomas

et al. 2011

Gut

254

198

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Objectives To assess the variation in risk-adjusted 30-day postoperative mortality for patients with colorectal cancer between hospital trusts within the English NHS. Design Retrospective cross-sectional population-based study of data extracted from the National Cancer Data Repository. Setting All providers of major colorectal cancer surgery within the English NHS. Participants All 160 920 individuals who underwent major resection for colorectal cancer diagnosed between 1998 and 2006 in the English NHS. Main outcome measures National patterns of 30-day postoperative mortality were examined and logistic binary regression was used to study factors associated with death within 30 days of surgery. Funnel plots were used to show variation between trusts in risk-adjusted mortality.Results Overall 30-day mortality was 6.7% but decreased over time from 6.8% in 1998 to 5.8% in 2006. The largest reduction in mortality was seen in 2005 and 2006. Postoperative mortality increased with age (15.0% (95% CI 14.1% to 15.9%) for those aged >80 years), comorbidity (24.2% (95% CI 22.0% to 26.5%) for those with a Charlson comorbidity score $3), stage of disease (9.9% (95% CI 9.3% to 10.6%) for patients with Dukes' D disease), socioeconomic deprivation (7.8% (95% CI 7.2% to 8.4%) for residents of the most deprived quintile) and operative urgency (14.9% (95% CI 14.2% to 15.7%) for patients undergoing emergency resection). Risk-adjusted control charts showed that one trust had consistently significantly better outcomes and three had significantly worse outcomes than the population mean. Conclusions Significant variation in 30-day postoperative mortality following major colorectal cancer surgery existed between NHS hospitals in England throughout the period 1998e2006. Understanding the underlying causes of this variation between surgical providers will make it possible to identify and spread best practice, improve outcomes and, ultimately, reduce 30-day postoperative mortality following colorectal cancer surgery.

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“…Furthermore, comparisons of the information held in HES to that collected by clinical trials suggests that agreement is good for cases of confirmed cancer. 35 As a result, such linked data will provide the most robust figures possible.…”

Section: Discussionmentioning

confidence: 99%

Post-colonoscopy colorectal cancer (PCCRC) rates vary considerably depending on the method used to calculate them: a retrospective observational population-based study of PCCRC in the English National Health Service

Morris

Rutter

Finan

et al. 2014

Gut

136

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ObjectivePost-colonoscopy colorectal cancer (PCCRC) is a key quality indicator of colonoscopy. This study compares methods for defining PCCRC rates, proposes a new method of calculating them and quantifies them across the English National Health Service (NHS).DesignThis retrospective observational population-based study involved all individuals with a first primary diagnosis of colorectal cancer made between 2001 and 2010 and treated in the English NHS. Previously published methods for deriving PCCRC rates were applied to the linked routine health data for this population to investigate the effect on the rate. A new method, based on the year of the colonoscopy rather than colorectal cancer diagnosis, was then used to calculate PCCRC rates.ResultsOf 297 956 individuals diagnosed with colorectal cancer, a total of 94 648 underwent a colonoscopy in the 3 years prior to their diagnosis. The application of the published methods and exclusion criteria to the dataset produced significantly different PCCRC rates from 2.5% to 7.7%. The new method demonstrates that PCCRC rates within 3 years of colonoscopy (without exclusions) decreased in the English NHS over 8 years, falling from 10.6% to 7.3% for colonoscopies performed in 2001 and 2007 respectively.ConclusionsThe method used to determine PCCRC rates significantly affects findings with potential to substantially underestimate rates. To enable international benchmarking there needs to be a standardised method for defining PCCRC. This study proposes a new methodology using colonoscopy as a denominator and between 2001 and 2007 this method indicated an 8.6% PCCRC rate across the English NHS. It also demonstrated PCCRC rates have fallen over time.

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Comparison of treatment and outcome information between a clinical trial and the National Cancer Data Repository

Abstract: The National Cancer Data Repository demonstrates potential for informing clinical trials, but limitations prevent full intention-to-treat analyses.

Cited by 25 publications

References 15 publications

Population-based study of laparoscopic colorectal cancer surgery 2006–2008

Population-based study of laparoscopic colorectal cancer surgery 2006–2008

Thirty-day postoperative mortality after colorectal cancer surgery in England

Post-colonoscopy colorectal cancer (PCCRC) rates vary considerably depending on the method used to calculate them: a retrospective observational population-based study of PCCRC in the English National Health Service

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