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Outcomes of English Colorectal Cancer Care: Observation, Quantification and Comparison of Outcomes

Hicks, Gareth James (2018) Outcomes of English Colorectal Cancer Care: Observation, Quantification and Comparison of Outcomes. M.D. thesis, University of Leeds.

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Colorectal cancer is the fourth most common cancer in England, but English colorectal cancer outcomes have traditionally lagged behind those of similar income level countries. Reasons behind these poor outcomes are multi-factorial but include high numbers of elderly patients presenting with advanced disease and a stubbornly high rate of emergency admissions. Recent years have seen significant changes in the National Health Service’s approach to cancer treatment, alongside the development of population-level databases. This study uses population-level data, obtained through the National Cancer Data Repository to investigate how short-term outcomes of colorectal cancer patients within the English NHS between 1998 and 2010 have changed. Further, it seeks to evaluate the impact of the NHS Bowel Cancer Screening Program and novel technologies such as laparoscopic surgery and endoluminal stents on those outcomes. Risks factors for emergency colorectal cancer admission such as older age and increased co-morbidity remain although short-term mortality rates (30 and 90-day) appear to be falling. Length of stay for colorectal cancer patients fell markedly over the study period, aided by the introduction of laparoscopic surgery, whilst those who engaged in the screening program were seen to have a greater likelihood of presenting electively and with early stage disease. Endoluminal stents have a clear, but as yet undefined role to play in the management of the colorectal cancer patient, but do appear to offer certain advantages to selected patients. Population-level data allows evaluation of interventions in healthcare and comparison of international outcomes. English colorectal cancer outcomes improved over the study period reported here, but are still not at the level of our European and international neighbours. There remains much work to do to improve these outcomes; it is likely that population-level data will play a pivotal role in this.

Item Type: Thesis (M.D.)
Keywords: Colorectal, cancer, outcome, England
Academic Units: The University of Leeds > Faculty of Medicine and Health (Leeds) > School of Medicine (Leeds)
Identification Number/EthosID: uk.bl.ethos.772853
Depositing User: Mr Gareth Hicks
Date Deposited: 01 May 2019 11:24
Last Modified: 18 Feb 2020 12:50
URI: http://etheses.whiterose.ac.uk/id/eprint/23646

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