High hospital research participation and improved colorectal cancer survival outcomes: a population-based study

Abstract

ObjectiveIn 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.DesignData 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.ResultsMost 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.ConclusionsThere 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.

Treatment at high‐volume facilities and academic centers is independently associated with improved survival in patients with locally advanced head and neck cancer

“…[23][24][25] Teaching hospitals also may require physicians to stay abreast of the latest advances in head and neck cancer to train residents and fellow physicians. The presence of multidisciplinary tumor boards, 26 more robust peer review, 27 and greater access to clinical trials 28,29 also may influence outcomes at teaching hospitals in comparison with other centers.…”

Strengthening research in the NHS

“…A recent review concluded that “the UK punches above its weight internationally,”1 supported by NHS England, the National Institute for Health Research (NIHR), the emerging UK Research and Innovation, medical research charities such as the Wellcome Trust, our university partners, and industry. What is less well known is that research active NHS organisations have better patient outcomes2 and doctors find that research brings variety to their role, challenges them, and increases morale 3. Finally, investment in medical research has been found to provide a substantial long term return 4…”

Ophthalmology research in the UK’s National Health Service: the structure and performance of the NIHR’s Ophthalmology research portfolio

“…UK Clinical Trials Gateway) [6], there has been a growing awareness among patient groups of potential ocular research projects, and a drive from patients and their carers to seek out trials relevant to their ocular disease. Recent reports involving bowel cancer survival [7] have demonstrated that hospitals that engage in clinical research have better outcomes. This may well also be the case for Ophthalmology and underscores the need to encourage involvement of the remaining 24% (2017/18 data) of UK Ophthalmology Departments who are not currently participating in UK CRN Ophthalmology Portfolio studies.…”