National Bowel Cancer Audit Report 2011 - HQIP

7. Summary and Discussion
This year’s audit report confirms the progress that has been
observed over recent years. Case ascertainment for England
and Wales, is around 90 per cent and in several Networks the
figure is over 90 per cent; something Wales has achieved for
several time periods. Completeness of data submitted to the
Audit is variable and, whilst data that is submitted seems to
be fairly accurate when one compares with HES data, missing
data remains a very real problem.
There has been a good deal of national interest in postoperative
mortality figures and we renew the plea that the
six variables that are used for risk adjusted mortality are
completed in all cases. The use of HES linked audit data
has given added value to the National Bowel Cancer Audit
and it seems to have revealed several findings, in particular
the increased peri-operative mortality in those cases not
submitted, for whatever reason, to the Audit. We can,
nevertheless, be pleased with the year on year reduction
in post-operative mortality.
Several measures that indicate good practice are now
contained within the Audit and, where data completeness
is of a high standard, the results at a Trust level are of
considerable value in the peer review process. Almost all our
patients are being discussed at MDT meetings, are being
appropriately imaged with CT scanning and this, together
with the pathological examination of the resected specimen
and discussion at the MDT should lead to an integrated
clinico-pathological stage for almost all cases. We remain
disappointed that figures for the use of MR imaging in rectal
cancer and the use of radiotherapy for such cases
is so incomplete.
There are many other areas where the advances in the
management of colorectal cancer are reflected in the
Audit. The year on year increase in the use of laparoscopic
techniques is just one such example. This successful audit
also has the ability to highlight areas where further work is
needed. In studying the post-operative mortality issue there
is clearly a need to resolve, at a national level, areas where
improvements can be made. These may not be surgical but
most surely will be of interest to the multi-professional team.
Similarly, in accepting for the moment the late presentation
with advanced disease, the management of the emergency
admission, with its associated high mortality, also requires
further investigation. These are just two of the many areas
that could be the subject of a more focussed audit and the
changes in the cancer audits, currently under discussion,
together with a resolution to the uncertainty over sustainable
funding, should allow the Audit to develop, refine the data
set, and allow for a more flexible platform which can be
altered to suit the audit questions posed.
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