Addressing the variation in adjuvant chemotherapy treatment for colorectal cancer
- Addressing the variation in adjuvant chemotherapy treatment for colorectal cancer: Can a regional intervention promote national change? John C. Taylor, Daniel Swinson, Jenny F. Seligmann, Rebecca J. Birch, Alice Dewdney, Victoria Brown, Joanna Dent, Hannah L. Rossington, Philip Quirke, Eva J. A. Morris, YCR BCIP Study Group
Background
Surgery is the main treatment for bowel cancer. In order to try and reduce the chances of the cancer coming back, some patients are also offered additional treatment either before or after they have surgery. This is usually done by chemotherapy, which is where a patient is given a drug or a combination of drugs over a number of months. When chemotherapy is given after surgery, this is referred to as adjuvant chemotherapy. There are guidelines in place which help doctors decide when to offer this treatment to a patient.
The aim of this study is to identify which patients received adjuvant chemotherapy and look at whether treatment is more common in any particular groups of patients or at any particular hospital. This information could then be used to improve the guidance provided to doctors therefore improving the care of patients.
What did we do?
The differences in the use of adjuvant chemotherapy was investigated using data from all hospitals treating colorectal cancer in England. A more detailed investigation then took place focusing just on the hospitals within the Yorkshire and Humber region.
Alongside the investigation into the data, questionnaires about the uses of adjuvant chemotherapy were sent to the doctors who prescribe the chemotherapy, known as Oncologists, in the Yorkshire and Humber region.
A series of meetings for all Oncologists from the Yorkshire and Humber region were held to address the differences in adjuvant chemotherapy use both at a regional and national level. A further round of questionnaires were then sent to the Oncologists to see if the differences identified in the previous meetings had been addressed.
A final meeting took place during which a new set of guidelines was agreed in order to reduce the differences in treatment across the Yorkshire and Humber region.
What did we find?
The study found that there are large differences in the use of adjuvant chemotherapy for bowel cancer both nationally and regionally. Through bringing this information to the attention of the Oncologists in the Yorkshire and Humber region, all hospitals in the region agreed to a new set of guidelines which aims to reduce the differences in care that patients receive. This process could be copied in other regions in England.