Contents
Patient inclusion and data sources
The 2024 State of the Nation Report includes results for people in England and Wales diagnosed with bowel cancer 1 April 2022 – 31 March 2023.
Adjuvant chemotherapy and severe acute toxicity estimates include people undergoing major resection for pathological stage 3 colon cancer between 01 April 2020 and 30 November 2022.
APER/Hartmann’s and unclosed ileostomy estimates include people undergoing rectal cancer surgery between 01 April 2017 and 31 March 2022. Annual rectal cancer resection volume includes major resections for rectal cancer performed between 01 April 2022 and 31 March 2023.
30-day unplanned readmission, 30-day unplanned return to theatre and 90-day mortality are further restricted to patients undergoing surgery up to 30 June 2023. Two-year mortality estimates include people undergoing a major resection between 1 April 2020 and 31 March 2021. People undergoing both planned and emergency major resection are included.
The cancer registry dataset is linked to Hospital Episode Statistics (HES) and Patient Episode Database for Wales (PEDW) at patient level to obtain further information on patient care and follow-up such as stoma reversal and emergency readmissions in England/Wales. Linkage to Office for National Statistics records provides information about date and cause of death.
The cancer registry also links to the National Radiotherapy Dataset (RTDS) for information on radiotherapy treatment in England, and the Systemic Anti-Cancer Therapy database (SACT) for information on chemotherapy treatment in England.
Data Quality
Data completeness
% of relevant patient group with useable value of data item.
Management of all patients
Clinical Nurse Specialist
% of people with clinical nurse specialist information recorded.
% of people recorded as having been seen by a clinical nurse specialist or a member of their team, if clinical nurse specialist information is recorded.
Management of patients having major resection
At least 12 lymph nodes excised (%)
% of colon cancer patients undergoing major resection with a recorded number of lymph nodes, who had at least 12 lymph nodes examined, reported by the trust/MDT providing major resection.
Adjuvant chemotherapy (%)
% of adjuvant chemotherapy in people undergoing major resection for pathological stage 3 colon cancer between 01 April 2020 and 30 November 2022. These are unadjusted chemotherapy rates reported by the trust/MDT providing major resection. SACT and HES data are used for people treated in England and PEDW data are used for patients treated in Wales.
Severe acute toxicity after adjuvant chemotherapy (%)
% risk-adjusted overnight admission for severe acute toxicity in people receiving adjuvant chemotherapy for stage 3 colon cancer, reported by the trust/MDT providing chemotherapy. ICD-10 diagnosis codes in overnight admissions in HES/ PEDW from the first cycle of chemotherapy to 8 weeks after the last cycle of chemotherapy are used to identify severe acute toxicity. Estimates are risk-adjusted for age, sex, number of comorbidities, performance status and staging.
Rectal cancer patients
Neo-adjuvant therapy (%)
% of rectal cancer patients having short- or long-course radiotherapy prior to major resection, reported by the trust/MDT providing major resection.
Rectal volume
Reported number of rectal major resections between 1 April 2022 and 31 March 2023, reported by the trust/MDT providing major resection.
APER/Hartmann’s (%)
% of people whose rectal cancer resection is an abdomino-perineal excision of rectum (APER)/pelvic exenteration/Hartmann’s 1 April 2017 to 31 March 2022, reported by the trust/MDT providing major resection.
Compare trust outcomes
Trust outcomes are reported reported by the trust/MDT providing major resection. Funnel plots display trust risk-adjusted outcomes. The funnel regions represent the 95 per cent limit and the 99.8 per cent limit for trusts compared to the national average. Those trusts with results outside the outer (99.8 per cent) limit are considered potential outliers. Previous years of results show funnel plots for all five trust outcomes.
Risk adjustment is performed using T-stage, N-stage, M-stage, site of tumour, performance status, mode of admission (elective/emergency), number of co-morbidities according to HES/PEDW, sex, and an interaction between age and distant metastases. Missing values are imputed using Multiple Imputation. The model for two-year mortality additionally includes interactions between follow-up time (0-3 months after surgery vs. 3-24 months after surgery) and all of the risk factors.
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