Gaps identified in bowel cancer care

Around one in 20 people in the UK will develop bowel cancer during their lifetime. Although it is the third most common cancer in the UK and the second leading cause of cancer deaths, with over 16,000 people dying from it each year, there has been significant progress achieved in improving outcomes, in recent years. According to the annual report from the National Bowel Cancer Audit, which analysed care provided to 41,000 patients in England and Wales between April 2006 and July 2008, post-operative mortality decreased from around 7% of patients in 2001 to 4.5%. While there have been improvements in the care of bowel cancer patients, however, more still needs to be done if national recommendations are to be met. Paul Finan, consultant coloproctologist and clinical lead of the National Bowel Cancer Audit, commented: “The audit has demonstrated that the outlook for bowel cancer patients has never been better and standards of care are moving in the right direction. But it also provides hints to where we need to progress more quickly towards the very best standards and save more lives in the future.” NICE recommends that all patients should have their case discussed by a multidisciplinary team including radiologists, pathologists, anaesthetists and surgeons, rather than a single clinician making decisions about the best course of treatment. In the audit, figures showed that 84% of cases were discussed by a multidisciplinary team in 2007 to 2008 – up from 80% in 2006-07, but still short of the 100% target. Specialist nursing is becoming more common, with over half of patients receiving advice and support from a specialist bowel cancer nurse, compared with 41% the previous year. NICE recommends that all patients should have access to this level of nursing expertise, indicating that there is still progress to be made.

Diagnostic imaging

 Access to advanced diagnostic imaging such as magnetic resonance has improved, as has access to computerised tomography scans. However, the audit showed that 61% of patients with colorectal cancer were reported to have had a CT scan during their care, yet the NICE guidance is that 100% of patients should be given a CT scan. The report also pointed out that a quarter of patients are not getting the stage of their disease recorded, which means that they may not receive the best possible choice of treatment. The guidelines from the Association of Coloproctology of Great Britain and Ireland for the Management of Colorectal Cancer, 2007, recommend that all patients with colon or rectal cancer should have pre-operative staging by CT scan to determine the local extent of the disease and the presence of lung or liver metastases. In patients presenting with obstruction, CT scanning should be carried out to exclude pseudo-obstruction before operation.