title: The impact of the Calman-Hine report on the processes and outcomes of care for Yorkshire's colorectal cancer patients.
abstract: The 1995 Calman-Hine plan outlined radical reform of the UK's cancer services with the aim of improving outcomes and reducing inequalities in NHS cancer care. Its main recommendation was to concentrate care into the hands of site-specialist, multi-disciplinary teams. This study aimed to determine if the implementation of Calman-Hine cancer teams was associated with improved processes and outcomes of care for colorectal cancer patients. The design included longitudinal survey of 13 colorectal cancer teams in Yorkshire and retrospective study of population-based data collected by the Northern and Yorkshire Cancer Registry and Information Service. The population was all colorectal cancer patients diagnosed and treated in Yorkshire between 1995 and 2000. The main outcome measures were: variations in the use of anterior resection and preoperative radiotherapy in rectal cancer, chemotherapy in Dukes stage C and D patients, and five-year survival. Using multilevel models, these outcomes were assessed in relation to measures of the extent of Calman-Hine implementation throughout the study period, namely: (i) each team's degree of adherence to the Manual of Cancer Service Standards (which outlines the specification of the 'ideal' colorectal cancer team) and (ii) the extent of site specialisation of each team's surgeons. Variation was observed in the extent to which the colorectal cancer teams in Yorkshire had conformed to the Calman-Hine recommendations. An increase in surgical site specialisation was associated with increased use of preoperative radiotherapy (OR=1.43, 95% CI=1.04-1.98, P<0.04) and anterior resection (OR=1.43, 95% CI=1.16-1.76, P<0.01) in rectal cancer patients. Increases in adherence to the Manual of Cancer Service Standards was associated with improved five-year survival after adjustment for the casemix factors of age, stage of disease, socioeconomic status and year of diagnosis, especially for colon cancer (HR=0.97, 95% CI=0.94-0.99 P<0.01). There was a similar trend of improved survival in relation to increased surgical site specialisation for rectal cancer, although the effect was not statistically significant (HR=0.93, 95% CI=0.84-1.03, P=0.15). In conclusion, the extent of implementation of the Calman-Hine report has been variable and its recommendations are associated with improvements in processes and outcomes of care for colorectal cancer patients.
authors.affiliation: Cancer Epidemiology Group, Centre for Epidemiology and Biostatistics, The University of Leeds, Arthington House, Cookridge Hospital, Leeds LS16 6QB, UK. eva.morris@nycris.leedsth.nhs.uk
authors.forename: E
authors.initials: E
authors.lastname: Morris
authors.forename: R A
authors.initials: RA
authors.lastname: Haward
authors.forename: M S
authors.initials: MS
authors.lastname: Gilthorpe
authors.forename: C
authors.initials: C
authors.lastname: Craigs
authors.forename: D
authors.initials: D
authors.lastname: Forman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003110:Colonic Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D016522:Oncology Service, Hospital / Q000458:organization & administration* / Q000706:statistics & numerical data; D010348:Patient Care Team / Q000458:organization & administration* / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D012004:Rectal Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D012042:Registries / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016019:Survival Analysis; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D006113:United Kingdom