Breast cancer services - a population-based study of service reorganization

Abstract

The Calman-Hine Report in England and Wales and the Campbell Report in Northern Ireland initiated a major reorganization of cancer services with the aim of improving the provision and delivery of care to cancer patients. In this paper, breast cancer patients diagnosed in 1996 and those diagnosed in 2001 are compared in order to examine the extent of service change in Northern Ireland. Patients living in Northern Ireland with invasive breast cancer diagnosed in either 1996 or 2001 were identified from the Northern Ireland Cancer Registry database. Information relating to the delivery of cancer care to these patients was collected by retrospective review of their case notes. Breast cancer surgery was performed in fewer hospitals (13 versus 21) by fewer surgeons (19 versus 40) with 98 percent of patients operated on by designated breast surgeons in 2001. Clinically relevant axillary node excision increased with 765 (87 percent) patients having six or more nodes excised in 2001 compared to 515 (67 percent) in 1996 (p < 0.001). Recording of oestrogen receptor (ER) status improved from 23 percent in 1996 to 91 percent in 2001 (p < 0.001) and 81 percent of patients received hormone therapy appropriate to their ER status in 2001 compared with 6 percent in 1996 (p < 0.001). Communication between hospitals and patients and their GPs also improved. A significant change in service provision and delivery has occurred in Northern Ireland in line with the recommendations of the Campbell report. Further work is underway to ascertain the extent to which these changes may have impacted on patient outcomes.