National Bowel Cancer Audit Report 2011 - HQIP

All but 3 per cent of cases were discussed at a multidisciplinary
team meeting, a proportion that was very similar
across all cancer sites (Table 4.3). This percentage is higher
than in previous audit years, and is more complete than in
previous years. The percentage of cases discussed at a multidisciplinary
team meeting was at least 95 per cent in 89 per
cent of trusts (Appendix 2).
NICE guidelines recommend that 95 per cent to 100 per cent
of patients should be discussed at an MDT meeting.
The percentage of patients seen by a clinical nurse specialist
(CNS) is difficult to determine as a quarter of patients did
not have this information recorded (Table 4.3). Amongst
patients where this information was available, just above
80 per cent of colon cancer patients and 87 per cent of rectal
cancer patients were seen by a clinical nurse specialist. The
percentage of patients seen by a CNS varied between trusts,
with 15 trusts reporting that fewer than half of their patients
saw a CNS, but in three-quarters of trusts over 80 per cent
of patients saw a CNS (Appendix 2).
A much higher proportion of colon cancer patients
(28 per cent) had an urgent or emergency operation than
rectal cancer patients (12 per cent). Particular efforts need
to be made in this area as the urgency of procedure has
a major effect on post-operative outcome.
NICE guidance is that facilities and services should be
established to provide stenting for patients with intestinal
obstruction, particularly those with serious comorbidity,
so that high-risk emergency surgery may be avoided.
Just under 30 per cent of patients had a completely
laparoscopic procedure, regardless of cancer site.
The audit reports from 2009, 2010, together with the
current communication, confirm the expected increase
in laparoscopically completed procedures.
Characteristics of patients undergoing major surgery and
with a known cancer site are shown in Table 4.4.
NICE guidelines recommend that 100 per cent of patients
should be seen by a specialist nurse.
The proportion of patients who are recorded as having had
a CT scan, either by having a CT scan result reported or by
having a date of CT scan reported was over 80 per cent and
was similar across cancer sites. This figure is probably a more
accurate estimate of the use of CT imaging than previously
reported and, by the simple manoeuvre of using both date
and/or result of scan, the Audit is now producing a more
realistic figure for this measure. In 79 per cent of trusts at
least 80 per cent of patients are recorded as having had
a CT scan.
NICE guidelines recommend that 100 per cent of patients
should have a CT scan.
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