Clinical

British Journal of Cancer (2004) 91, 1477–1481. doi:10.1038/sj.bjc.6602118 www.bjcancer.com
Published online 5 October 2004

Effect of process standards on survival of patients with head and neck cancer in the south and west of England

Contributors: MB developed the idea for this study. DB gathered and analysed the quantitative data, and PK performed statistical analysis and produced the figures. MB led on the writing of the paper with contributions from DB, PK** and the members of the tumour panel. MB is guarantor

Funding: No additional funding above normal SWCIS income. Previous studies have shown that the cost of data collection is around £50.00 per patient

Competing interests: None

Ethical approval: Not needed

M Birchall1, D Bailey2 and P King2 on behalf of the South West Cancer Intelligence Service Head and Neck Tumour Panel

  1. 1University of Liverpool, University Hospital Aintree, Liverpool L9 7AL, UK
  2. 2South West Cancer Intelligence Service, Winchester SO22 5DH, UK

Correspondence: Professor M Birchall, E-mail: martinbirchall@btinternet.com

Received 10 May 2004; Revised 7 July 2004; Accepted 8 July 2004; Published online 5 October 2004.

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Abstract

The aim of the study was to compare standards for the process of care and 2-year survival between two cohorts of patients with head and neck cancer in the south and west of England. A total of 566 and 727 patients presented in 1996–97 and 1999–2000, respectively. The median number of cases treated per surgeon was 4 (1997, range 1–26) and 4 (2000, 1–23) and per radiotherapist was 10 (1–51) and 19 (1–70). For all 'nontemporal' standards, the overall standard increased, without reaching minimum high targets, while most 'waiting times' increased. Overall 2-year survival was 64.1% in 1997 and 65.1% in 2000. There was no difference in survival between networks (range 56–68, 1997, log-rank test 4.1, P=0.4; 62–69, 2000, log-rank test 1.26, P=0.69). Patients assessed by a multidisciplinary clinic exhibited improved survival (1997: P=0.1; 2000: hazard ratio 0.7, P=0.02), as did those with a pretreatment chest X-ray (hazard ratio 0.7, P=0.03). Despite an increased incidence, standards for the process of care for patients with head and neck cancer improved between 1996 and 2000, while waiting times increased and 2-year survival rates remained unaltered. Two out of five networks demonstrated centralisation of services between audits. Being seen in a multidisciplinary clinic correlated strongly with patient survival.

Keywords:

head and neck cancer, standards, survival, waiting times