title: High hospital research participation and improved colorectal cancer survival outcomes: a population-based study.
abstract: In 2001, the National Institute for Health Research Cancer Research Network (NCRN) was established, leading to a rapid increase in clinical research activity across the English NHS. Using colorectal cancer (CRC) as an example, we test the hypothesis that high, sustained hospital-level participation in interventional clinical trials improves outcomes for all patients with CRC managed in those research-intensive hospitals.
  
  
  
  Data for patients diagnosed with CRC in England in 2001-2008 (n=209 968) were linked with data on accrual to NCRN CRC studies (n=30 998). Hospital Trusts were categorised by the proportion of patients accrued to interventional studies annually. Multivariable models investigated the relationship between 30-day postoperative mortality and 5-year survival and the level and duration of study participation.
  
  
  
  Most of the Trusts achieving high participation were district general hospitals and the effects were not limited to cancer 'centres of excellence', although such centres do make substantial contributions. Patients treated in Trusts with high research participation (≥16%) in their year of diagnosis had lower postoperative mortality (p<0.001) and improved survival (p<0.001) after adjustment for casemix and hospital-level variables. The effects increased with sustained research participation, with a reduction in postoperative mortality of 1.5% (6.5%-5%, p<2.2×10-6) and an improvement in survival (p<10-19; 5-year difference: 3.8% (41.0%-44.8%)) comparing high participation for ≥4 years with 0 years.
  
  
  
  There is a strong independent association between survival and participation in interventional clinical studies for all patients with CRC treated in the hospital study participants. Improvement precedes and increases with the level and years of sustained participation.
authors: Leeds Institute of Cancer and Pathology, University of Leeds, St James's University Hospital, Leeds, UK.|Cancer Research UK Centre, University of Leeds, St James's University Hospital, Leeds, UK.
authors: Amy
authors: 0000-0002-0335-7801
authors: A
authors: Downing
authors: Leeds Institute of Cancer and Pathology, University of Leeds, St James's University Hospital, Leeds, UK.|Cancer Research UK Centre, University of Leeds, St James's University Hospital, Leeds, UK.|MRC Bioinformatics Centre, Leeds, UK.
authors: Eva Ja
authors: 0000-0002-1075-6544
authors: EJ
authors: Morris
authors: Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK.
authors: Neil
authors: N
authors: Corrigan
authors: Leeds Institute of Cancer and Pathology, University of Leeds, St James's University Hospital, Leeds, UK.|Cancer Research UK Centre, University of Leeds, St James's University Hospital, Leeds, UK.|Leeds Teaching Hospitals NHS Trust, Leeds, UK.
authors: David
authors: D
authors: Sebag-Montefiore
authors: Leeds Teaching Hospitals NHS Trust, Leeds, UK.|National Cancer Intelligence Network, London, UK.
authors: Paul J
authors: PJ
authors: Finan
authors: National Cancer Intelligence Network, London, UK.
authors: James D
authors: JD
authors: Thomas
authors: Cancer Research UK, London, UK.
authors: Michael
authors: M
authors: Chapman
authors: Department of Health, Research and Development, London, UK.
authors: Russell
authors: R
authors: Hamilton
authors: Department of Health, Research and Development, London, UK.|Clinical Research Facilities, and Cancer Research, University of Exeter Medical School, Exeter, UK.
authors: Helen
authors: H
authors: Campbell
authors: NIHR Cancer Research Network, Leeds, UK.|Edinburgh Cancer Research Centre, University of Edinburgh, Western General Hospital, Edinburgh, UK.
authors: David
authors: D
authors: Cameron
authors: NIHR Cancer Research Network, Leeds, UK.|MRC Clinical Trials Unit at University College London, London, UK.
authors: Richard
authors: R
authors: Kaplan
authors: MRC Clinical Trials Unit at University College London, London, UK.
authors: Mahesh
authors: M
authors: Parmar
authors: NCRI Consumer Liaison Group, NIHR Cancer Research Network, Leeds, UK.
authors: Richard
authors: R
authors: Stephens
authors: Leeds Institute of Cancer and Pathology, University of Leeds, St James's University Hospital, Leeds, UK.|Cancer Research UK Centre, University of Leeds, St James's University Hospital, Leeds, UK.|Leeds Teaching Hospitals NHS Trust, Leeds, UK.|NIHR Cancer Research Network, Leeds, UK.
authors: Matt
authors: M
authors: Seymour
authors: Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK.
authors: Walter
authors: W
authors: Gregory
authors: Leeds Institute of Cancer and Pathology, University of Leeds, St James's University Hospital, Leeds, UK.|Cancer Research UK Centre, University of Leeds, St James's University Hospital, Leeds, UK.|Leeds Teaching Hospitals NHS Trust, Leeds, UK.
authors: Peter
authors: P
authors: Selby
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D035843:Biomedical Research / Q000706:statistics & numerical data*; D002986:Clinical Trials as Topic / Q000706:statistics & numerical data*; D015179:Colorectal Neoplasms / Q000401:mortality* / Q000601:surgery; D004739:England; D005260:Female; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D020379:Risk Adjustment; D013222:State Medicine; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome
keywords: CLINICAL TRIALS; COLORECTAL CANCER; HEALTH SERVICE RESEARCH