Is the performance of cancer services influenced more by hospital factors or by specialization?

Abstract

The Cancer Plan for England, introduced in 2000, has promoted cancer service specialization. We have investigated how far specialization and general hospital factors each contributed to service performance for four common cancers-breast, colorectal, lung and prostate-at the time of the Cancer Plan. Performance measures of service standards, waiting time to treatment, satisfaction with care, in-hospital mortality and population-level survival were identified from secondary data sets for 167 acute hospitals and 34 cancer networks in England. We correlated rankings of networks and hospitals between the data sets using non-parametric statistics. At cancer network level, peer-review service standards were associated (P < 0.05) with 1-year survival for colorectal and lung cancers, and waiting times for lung cancer. At hospital level, standards were associated (P < 0.01) with waiting time to treatment for breast and colorectal cancers. However, there were stronger associations between specializations within hospitals: rankings of breast, colorectal and prostate cancers were highly associated (P < 0.001) for 5-year survival, patient satisfaction, standards and in-hospital mortality. Hospital-level differences appear to contribute more to variations in cancer performance than specialization differences within hospitals. The findings may be used for planning and commissioning better cancer services.

Quality indicators for colorectal cancer surgery and care according to patient-, tumor-, and hospital-related factors

“…Potential mechanisms underlying the relationships between volume and survival after colorectal surgery do not seem to have been characterized [42]. It is important to remember that many hospital-related factors, such as types of services, multidisciplinary teams and internal quality programs potentially explain differences in care management and cancer survival [43,44]. However, in 2009, the French cancer plan implemented a system authorizing cancer care only in hospitals above a specific volume threshold.…”

Reporting cancer patients' experiences of care for quality improvement: analysis of 2000 and 2004 survey results for South East England

“…Only one UK study has compared the results of patient experience data with cancer registry data. McCarthy and colleagues [21] averaged the original 2000 responses of patients with the same cancer into a single score for each hospital trust and aggregated these scores at network level. They then correlated these scores with 1 and 5-year relative survival figures, calculated from registry data for the residents of each cancer network area diagnosed between 1996 and 2001.…”

Attributes Contributing to Superior Outcomes in the Surgical Management of Early-Stage Lung Cancer and Examples of Implementing Improvement

“…22,32 Contrary wise, hospital-level differences have been reported to be more important than specialization. 33 The benefit of specialization to safety (decreased operative morbidity and mortality), cost (decreased complications and fewer prolonged hospitalizations), and efficacy (improved longterm survival) of lung cancer surgery is considered no longer controversial by some. 34 Although perioperative costs would seem to be intuitively higher with complications or death, there are few substantiating data.…”