Bowel cancer surgery ‘increases chances’
pharmafile | July 5, 2013 | News story | Sales and Marketing | HSCIC, NHS, bowel cancer
Having surgery to treat bowel cancer massively increases a patient’s chance of survival, according to data from a new national survey.
Those who have an operation are almost twice as likely to live two years beyond diagnosis as those who do not, says the National Bowel Cancer Audit of more than 50,000 patients, which was commissioned by the Healthcare Quality Improvement Partnership.
Developed by the Association of Coloproctology of Great Britain and Ireland, the Health and Social Care Information Centre (HSCIC) and the Royal College of Surgeons of England, the data confirms for the first time this disparity in survival rates.
However, the survey also found that the proportion of patients admitted as emergency cases remained at what doctors called a ‘stubborn’ 21% to 22% – or 5,250 patients diagnosed in 2011-2012.
This figure has not changed significantly in four years, which is important because the risk of post-operative death is much higher than for elective operations, with one in seven patients undergoing emergency surgery in 2011-12 not surviving 90 days after surgery.
The fact that this rate of emergency admissions has not changed also suggests that more might need to be done to raise awareness about the signs and symptoms of bowel cancer.
This is a thorny issue for health authorities: last year the government admitted that its £9 million cancer awareness campaigns – which included bowel cancer – were built upon failed pilots which had not increased detection of the disease.
The new survey showed that four in five patients who underwent major surgery in England and Wales between April 2008 and March 2010 lived beyond two years of diagnosis – while over the same period only two out of five patients who did not have this intervention lived for the same amount of time.
The report’s authors suggest that more work is needed to better define the reasons – which include factors such as age and physical frailty – why some patients do not have major surgery.
The audit report also found that among nearly 30,000 people diagnosed with bowel cancer between April 2011 and March 2012 – post-operative survival ‘is at an all-time high’.
Out of 17,250 having surgery, 16,450 (95.5%) were alive 90 days after their operation, compared with 94.7% in 2010-11 and 93.9% in 2008-09 – a reduction in mortality from 6.1% to 4.5% in four years.
“Correct patient selection and postoperative care has delivered a fall in postoperative mortality of one third in just a few years,” said Nigel Scott, audit clinical lead and consultant colorectal surgeon at the Royal Preston Hospital.
“In addition these better outcomes immediately after surgery are matched by 80% of patients surviving at least two years or more – a testimony to bowel cancer multidisciplinary working in England and Wales,” he added.
But Scott admitted that the downside continues to be the much poorer outcomes associated with not operating because of advanced disease.
“Blood, bowels and poo tend to get sat on, as embarrassment puts people off from seeing the doctor,” he said. “Getting past the bathroom door and seeking the support of a health professional is the best means of finding a cancer as soon as possible.”
There is also an issue with late emergency admissions due to a blocked bowel, he went on.
“These emergency bowel cancer patients tend to be older and frailer and out-of-hours provision of services, including interventional radiology and stenting, are patchy,” Scott concluded.
Adam Hill
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