Centralised treatment, entry to trials and survival

Abstract

S_.mary A review was carried out of the published literature on survival rates for cancer in relation to patterns of organisation of medical care, specifically treatment at specialist centres or at hospitals treating larger numbers of patients and treatment by protocol, usually within the context of a clinical trial. Centralised referral or entry to trials was frequently associated with a higher survival rate, particularly for the less common cancers, and was never found to be associated with a lower survival rate. Few (Chouillet et al., 1994). Analyses of survival in relation to organisational factors have yet to appear from either of these studies.Finally, for 1984 onwards two electronic databases, Medline and Embase, were searched on the Silver Platter Cancer CD. Tables I-XI contain 32 references included on Cancer CD and already known to the author before searching began. Of these, 14 (44%) could be retrieved by a search of medical subject headings (MESH) containing at least one of the terms survival, outcome, prognosis, mortality and at least one of hospitals, protocols, cancer care facilities, referral, health services. Four additional references not previously known were found in this search, making a total of 18 publications, and these accounted for 2.8% of the total of 649 references so indexed. Extending the search to other fields or by additional keywords increased the total number of references retrieved by a much greater proportion than it did the number of relevant publications found. This is a considerably worse result than that found by Silagy (1993)

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“…This 'trial effect', also known as the 'Hawthorn effect', has been explored in at least four systematic reviews (Stiller, 1994), (Braunholtz et al, 2001), (Peppercorn et al, 2004), (Vist Gunn et al, 2008). Although their conclusions differ regarding as to the extent to which trials actually have benefit, all these authors agree that it is more likely that trials have a positive than negative effect on the outcomes for those taking part.…”

Breast cancer teams: the impact of constitution, new cancer workload, and methods of operation on their effectiveness

“…Therapy Three measures covering surgery, radiotherapy, and chemotherapy were used, that is, the proportions of new breast cancer patients who received conservation surgery; in whom conservation surgery was followed by radiotherapy; and who were Clinical innovation Three measures were used: that is, who were aged under 70 years, and received induction chemotherapy; entered patients into any of nine open national clinical trials (Stiller, 1989(Stiller, , 1994; routinely measured oestrogen receptor status.…”

Will the Scottish Cancer Target for the year 2000 be met? The use of cancer registration and death records to predict future cancer incidence and mortality in Scotland

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