National Cancer Data Repository Research Articles

Time trends in service provision and survival outcomes for patients with renal cancer treated by nephrectomy in England 2000-2010.

ObjectiveTo describe the temporal trends in nephrectomy practice and outcomes for English patients with renal cell carcinoma (RCC).Patients and MethodsAdult RCC nephrectomy patients treated between 2000 and 2010 were identified in the National Cancer Data Repository and Hospital Episode Statistics, and followed‐up until date of death or 31 December 2015 (n = 30 763). We estimated the annual frequency for each nephrectomy type, the hospital and surgeon numbers and their case volumes. We analysed short‐term surgical outcomes, as well as 1‐ and 5‐year relative survivals.ResultsAnnual RCC nephrectomy number increased by 66% during the study period. Hospital number decreased by 24%, whilst the median annual hospital volume increased from 10 to 23 (P < 0.01). Surgeon number increased by 27% (P < 0.01), doubling the median consultant number per hospital. The proportion of minimally invasive surgery (MIS) nephrectomies rose from 1% to 46%, whilst the proportion of nephron‐sparing surgeries (NSS) increased from 5% to 16%, with 29% of all T1 disease treated with partial nephrectomy in 2010 (P < 0.01). The 30‐day mortality rate halved from 2.4% to 1.1% and 90‐day mortality decreased from 4.9% to 2.6% (P < 0.01). The 1‐year relative survival rate increased from 86.9% to 93.4%, whilst the 5‐year relative survival rate rose from 68.2% to 81.2% (P < 0.01). Improvements were most notable in patients aged ≥65 years and those with T3 and T4 disease.ConclusionsSurgical RCC management has changed considerably with nephrectomy centralisation and increased NSS and MIS. In parallel, we observed significant improvements in short‐ and long‐term survival particularly for elderly patients and those with locally advanced disease.

Survival differences in childhood and young adult acute myeloid leukemia: A cross-national study using US and England data

BackgroundAcute myeloid leukemia (AML) is a serious disease with complex etiology and marked variation in survival. Known prognostic factors include AML subtypes, age at diagnosis and sex. However, survival outcomes may vary across healthcare systems. In this study, we evaluated the survival patterns in individuals diagnosed with AML at ages 0–24 years in the US and England between prognostic features and across countries. MethodsWe obtained data on 4387 and 2194 subjects from the US Surveillance Epidemiology and End Result registries and UK National Cancer Data Repository. Subjects were diagnosed and followed in 1995–2014. Kaplan-Meier curve and stratified Cox proportional hazards regression were used in the analysis. ResultsOverall risk of mortality was 23% lower in English patients compared to that in the US patients (adjusted hazard ratio (aHR), 95% confidence Interval (CI): 0.77, 0.71–0.84). Survival difference of similar extent was observed in subgroups of sex and age at diagnosis. However, mortality risks between two countries varied substantially across AML subtypes, especially in AML inv(16) (1.81, 0.61–5.34), AML with minimal differentiation (0.54, 0.25–1.17), AML without maturation (0.38, 0.20–0.74) and AML with maturation (0.52, 0.31–0.86). ConclusionsSimilar to the population trend, mortality risk across sex, age at diagnosis, and most AML subtypes was lower in England. Survival outcome for AML with and without maturation in England was better than the population trend, while that for AML inv(16) was worse. Our findings suggest that future etiologic and policy research may uncover the underlying mechanisms and contribute to closing these morality gaps.

Validation of Cancer Cases Using Primary Care, Cancer Registry, and Hospitalization Data in the United Kingdom.

In the United Kingdom, hospital or cancer registry data can be linked to electronic medical records for a subset of general practices and years. We used Clinical Practice Research Datalink data (2004-2012) from patients treated for overactive bladder. We electronically identified provisional cases of 10 common cancers in General Practitioner Online Database data and validated them by medical profile review. In practices with linkage to Hospital Episodes Statistics and National Cancer Data Repository (2004-2010), we validated provisional cancer cases against these data sources. This linkage also let us identify additional cancer diagnoses in individuals without cancer diagnosis records in the General Practitioner Online Database. Among 50,840 patients, 1,486 provisional cancer cases were identified in the General Practitioner Online Database for 2004-2012. Medical profile review confirmed 93% of 661 cases in nonlinked practices (range, 100% of non-Hodgkin lymphomas and uterine cancer to 77% of skin melanomas) and 96% of 825 cases in linked practices (100% of kidney and uterine cancers to 92% of melanomas). In the subset of linked practices, for 2004-2010, 720 cases were confirmed, of which 68% were identifiable in the General Practitioner Online Database (range, 90% of breast to 36% of kidney cancers). Most cases of cancer identified electronically in the General Practitioner Online Database were confirmed. A substantial proportion of cases, especially of cancer types not typically managed by general practitioners, would be missed without Hospital Episodes Statistics and National Cancer Data Repository data (and are likely missed in nonlinked practices). See video abstract at, http://links.lww.com/EDE/B315. European Union electronic Register of Post-Authorisation Studies (EU PAS Registry) number EUPAS5529, http://www.encepp.eu/encepp/viewResource.htm?id=11107.

Can routine data be used to support cancer clinical trials? A historical baseline on which to build: retrospective linkage of data from the TACT (CRUK 01/001) breast cancer trial and the National Cancer Data Repository

BackgroundRandomised clinical trials (RCTs) are the gold standard for evaluating new cancer treatments. They are, however, expensive to conduct, particularly where long-term follow-up of participants is required. Tracking participants via routine datasets could provide a cost-effective alternative for ascertaining follow-up information required to evaluate disease outcomes. This project explores the potential for routine data to inform cancer trials, using, the historical National Cancer Data Repository (NCDR) for English NHS sites and, for validation, mature data available from the TACT trial.MethodsDatasets were matched using patients’ NHS number, date of birth (dob) and name/initials. Demographics, clinical characteristics and outcomes were assessed for agreement and completeness. Overall survival was compared between NCDR and TACT.ResultsA total of 3151 patients underwent linkage; 3047 (96.7%) of which had matched records. Extensive cleaning was required for some registry data fields, e.g. cause of death, whilst others had large amounts of missing data, e.g. tumour size (22.1%). Other data had high levels of matching such as dob (99.6%) and date of death (89.6%). There was no evidence of differential survival rates (8-year survival: TACT = 75% (95% CI 73, 76); NCDR = 76% (95% CI 74, 77)).ConclusionsData quality and completeness requires improvement before routine data could be used for RCTs. Introduction of new routine datasets, including COSD, is welcomed although reporting of disease-recurrence events remains a concern. Prospective validation of such datasets is required before RCTs can confidently switch patient follow-up to utilise routinely collected NHS-based data.TACT Trial registrationClinicaltrials.gov NCT00033683, registered on 9 April 2002; ISRCTN79718493, registered on 1 July 2001.

Innovative Solutions for Clinical Trial Follow-up: Adding Value from Nationally Held UK Data

Clinical trials provide the data that underpin evidence-based oncological practice. Over and above their primary outcome measures, collected and analysed by the clinical trials unit, trials provide an opportunity to generate a wide range of additional information over a prolonged period of time. Nationally held data have potential to facilitate longer term follow-up and explore associated toxicities and downstream consequences and in the UK include data from secondary care, including hospital episode statistics, national chemotherapy and radiotherapy datasets and primary care records. Specific to use in oncological practice, the National Cancer Data Repository contains linked data from a variety of sources for patients with a diagnosis of cancer, both cancer and non-cancer related. The challenge of using these data in clinical trials relates to the need to extract identifiable patient data, with the associated ethical and legal issues. The data access processes are time consuming and require evidence of information governance compliance.This overview article reviews the current data available, the current and potential uses both within and outside clinical trials and the challenges encountered in the process of acquiring data. We focus specifically on the use of nationally held data for non-cancer outcomes, including toxicity and associated conditions.

Are survival and mortality rates associated with recruitment to clinical trials in teenage and young adult patients with acute lymphoblastic leukaemia? A retrospective observational analysis in England

ObjectiveParticipation rates in clinical trials are low in teenagers and young adults (TYA) with cancer. Whilst the importance of clinical trials in informing best practice is well established, data regarding...

Association of Coloproctology of Great Britain & Ireland (ACPGBI): Guidelines for the Management of Cancer of the Colon, Rectum and Anus (2017) - Audit and Outcome Reporting.

Defining quality in colorectal cancer surgery is complex. Single metrics that describe safety or performance fail to adequately describe the complexity of colorectal care (Almoudaris et al., 2013). Meaningful performance measurement is dependent upon a) case-mix adjustment, b) an understanding of volume-outcome effects and c) reliable data sources. Old age and patient co-morbidity significantly increase the likelihood of peri-operative events and mortality. To enable comparison of surgical performance, adjustment must be made for case-mix differences between providers. Scoring systems, such as Charlson (Charlson et al., 1987) and Elixhauser (Elixhauser et al., 1998) are used widely to case-mix adjust models derived from large clinical datasets. Currently risk stratification models used for comparison of outcomes have limitations as they do not adjust for case mix, including BMI (body mass index) and socio-economic deprivation (Harris et al., 2009; Haydon et al., 2006). The main data sources in the United Kingdom are; The National Bowel Cancer Audit (NBOCA) is commissioned by the Healthcare Quality Improvement Partnership (HQIP) delivered by the Health and Social Care Information Centre working in collaboration with the ACPGBI. The data are submitted from various NHS Trusts in the UK and the Republic of Ireland via the Open Exeter system. These data are used to examine variation in surgical practice, to describe outcome following colorectal resections for cancer and to derive predictive models of mortality (Tan et al., 2007; Tekkis et al., 2003; Tilney et al., 2009). Findings are disseminated in an annual report. These datasets are primarily collected for administrative purposes but are increasingly used for clinical performance benchmarking. The Hospital Episode Statistics (HES) represents the dataset for NHS England [www.hesonline.nhs.uk] and Information Services Division Scotland (ISD) for Scotland [www.isdscotland.org]. Such databases comprise of clinical codes that relate to diagnoses, procedures and demographic information. These data can be used to examine procedure volumes and basic clinical outcomes, including inpatient mortality rates, readmission rates and length of hospital stay. HES data have been linked to other national datasets such as the Office of National Statistics and the Cancer Registry for additional clinical and outcome information, such as out-of-hospital survival and tumour staging. The latter National Cancer Data Repository (NCDR) has recently been used in research studies to compare institutional mortality rates following colorectal surgery in England (Morris et al., 2011). The NCDR can also been linked to the national Radiotherapy Dataset (RTDS) to investigate patterns of management of rectal cancer across the English NHS (Morris et al., 2016). Surgeon level reporting of colorectal cancer surgery outcomes to the UK public was introduced in 2013. Capture of information on patients undergoing planned colorectal resection for cancer (excluding appendiceal neoplasms) are included in analyses. Surgeon level reporting has been spearheaded by Cardiac Surgeons but there are concerns amongst many surgeons that unit level reporting may be more appropriate. The ACPGBI agreed to participate in the process as the Department of Health stated that it would proceed with, or without the involvement of the ACPGBI. There are concerns regarding the quality of data and limitations of their interpretation. There are discrepancies in both information technology infrastructure and the availability of data capture personnel. As of 2013, NHS England (through the Healthcare Quality Improvement Partnership) has published 90-day risk-adjusted mortality figures for colorectal cancer patients undergoing planned surgery on a hospital and surgeon basis. This is based on data submitted to NBOCA. Monitoring of outcomes is required to define acceptable quality of care in elective colorectal cancer surgery. For the reasons already cited comparison can only be made when funnel plots are used to adjust for operative volumes, when data are reliable and when case-mix has been adjusted for. Outcomes for emergency surgery are generally less favourable. The following figures represent some published outcomes following elective colorectal cancer surgery: Surgeons and trusts must make provisions for the prospective collection of accurate clinical data for submission to the National Bowel Cancer Audit (NBOCA). Recommendation grade B Omar Faiz has no conflicts of interest to declare.

Rate of positive diagnosis of skin cancer and its stage in two-week wait referrals in England according to age.

The incidence of skin cancer is increasing. The two-week wait conversion rate (TWWCR) is the percentage of urgent suspected skin cancer referrals that are confirmed as cancer. To examine the relationships between different epidemiological factors and TWWCR for malignant melanoma (MM) and cutaneous squamous cell carcinoma (SCC). We extracted data from the National Cancer Data Repository (NCDR) and National Cancer Waiting Times Monitoring Dataset between 2009 and 2010 for MM and SCC in England. We conducted partial correlation and stepwise multiple regression analysis on TWWCR, age, incidence, detection rate, tumour thickness (MM only), percentage MM/SCC and social deprivation. We also looked at the two-week wait referral rate (TWWRR) and incidence rate with respect to age. TWWCR was significantly correlated with age when partial correlation was used to control for the factors described above for MM (P < 0.05) and SCC (P < 0.001). Stepwise regression of these factors returned only age as significant in the final model for MM (P < 0.001) and SCC (P < 0.01). Incidence of MM and SCC increased with age. TWWRR also increase with age, but with higher rate in younger people relative to their incidence. Age is a predictor of TWWCR independent of the other factors measured, including thickness and incidence. This may be explained by the higher number of referrals for younger patients despite the lower incidence of skin cancer in this group. This may reflect a more appropriate rate of referral in order to achieve earlier diagnosis and better outcomes.

Non-transitional cell carcinoma only partly explains adverse survival outcomes in females with T1–T4 bladder cancer: A summary of UK epidemiological data

Objective: The objective of this article is to investigate why bladder cancer (BC) survival is worse in females using national cancer datasets. Patients and methods: All BC diagnoses since the year 2000 were identified from the National Cancer Data Repository (NCDR) using ICD-10 Code C67 (Bladder cancer T1–T4). Age-standardised relative survival rates for males and females diagnosed with BC between 2000 and 2010 were obtained from Public Health England. Results: Five-year relative survival of men with transitional cell carcinoma (TCC) BC (Code C67) was 61%, but in females was significantly less at 52%. One in four female BC (27%) patients are non-TCC, proportionately far more compared to 1:6 (16%) non-TCC BC in males. Five-year relative survival in non-TCC BC subtypes was notably reduced to 23% in females compared to 35% in men. Only 47% of patients with non-TCC BC receive surgical treatment compared to 82% for all BC. Conclusion: Relative survival from non-TCC BC is significantly less than the overall survival from TCC BC. Female patients with invasive BC have a worse survival than men. This is partly explained by the proportionately higher incidence of non-TCC BC in females, but women with TCC BC also have worse outcomes so other factors must contribute. Female gender should be recognised as an adverse risk factor in BC survival and influence management decisions.

A retrospective observational study of length of stay in hospital after colorectal cancer surgery in England (1998-2010).

The National Health Service (NHS) is facing financial constraints and thus there is considerable interest in ensuring the shortest but optimal hospital stays possible. The aim of this study was to investigate patterns of postoperative length of stay (LOS) stay across the English NHS and to identify factors that significantly influence both optimal and prolonged LOS.Data were obtained from the National Cancer Data Repository (NCDR). National patterns of LOS were examined and multilevel mixed effects logistic regression was used to study factors associated with an “ideal” (≤5 days) or a prolonged (≥21 days) LOS in hospital after major resection. Funnel plots were used to examine variation across hospitals in both risk-adjusted and unadjusted LOS.All 240,873 individuals who underwent major resection for colorectal cancer were diagnosed between 1998 and 2010 in the English NHS. The overall median LOS was 10 (interquartile range [IQR] 7–14 days) days, but it fell over time from 11 (IQR 9–15) days in 1998 to 7 (IQR 5–12) days in 2010. The proportion of people experiencing “ideal” LOS increased dramatically from 4.9% in 1998 to 34.2% in 2010, but the decrease in the proportion of patients who experienced a prolonged LOS was less marked falling from 11.2% to 8.4%, respectively. Control charts showed that there was significant variation in short and prolonged LOS across NHS trusts even after adjustment for case-mix.Significant variation in LOS existed between NHS hospitals in England throughout period 1998 to 2010. Understanding the underlying causes of this variation between surgical providers will make it possible to identify and spread best practice, improve services, and ultimately reduce LOS following colorectal cancer surgery.

Incidence of eyelid basal cell carcinoma in England: 2000–2010

IntroductionBasal cell carcinomas (BCCs) are the most frequently diagnosed type of skin cancer, with eyelid (including canthus) BCCs accounting for a notable proportion of these. Using population-based data from the...

Wide Variation in the Use of Radiotherapy in the Management of Surgically Treated Rectal Cancer Across the English National Health Service

AimsRadiotherapy is an important treatment modality in the multidisciplinary management of rectal cancer. It is delivered both in the neoadjuvant setting and postoperatively, but, although it reduces local recurrence, it does not influence overall survival and increases the risk of long-term complications. This has led to a variety of international practice patterns. These variations can have a significant effect on commissioning, but also future clinical research. This study explores its use within the large English National Health Service (NHS). Materials and methodsInformation on all individuals diagnosed with a surgically treated rectal cancer between April 2009 and December 2010 were extracted from the Radiotherapy Dataset linked to the National Cancer Data Repository. Individuals were grouped into those receiving no radiotherapy, short-course radiotherapy with immediate surgery (SCRT-I), short-course radiotherapy with delayed surgery (SCRT-D), long-course chemoradiotherapy (LCCRT), other radiotherapy (ORT) and postoperative radiotherapy (PORT). Patterns of use were then investigated. ResultsThe study consisted of 9201 individuals; 4585 (49.3%) received some form of radiotherapy. SCRT-I was used in 12.1%, SCRT-D in 1.2%, LCCRT in 29.5%, ORT in 4.7% and PORT in 2.3%. Radiotherapy was used more commonly in men and in those receiving an abdominoperineal excision and less commonly in the elderly and those with comorbidity. Significant and substantial variations were also seen in its use across all the multidisciplinary teams managing this disease. ConclusionDespite the same evidence base, wide variation exists in both the use of and type of radiotherapy delivered in the management of rectal cancer across the English NHS. Prospective population-based collection of local recurrence and patient-reported early and late toxicity information is required to further improve patient selection for preoperative radiotherapy.

Metformin use and survival from lung cancer: A population-based cohort study

Preclinical evidence suggests that metformin, a widely prescribed anti-diabetic drug, may inhibit lung cancer progression. We investigated whether metformin use was associated with decreased risk of cancer-specific mortality in lung cancer patients. This study included newly diagnosed lung cancer patients (identified from English National Cancer Data Repository, 1998–2009) with type 2 diabetes (based on UK Clinical Practice Research Datalink prescriptions and diagnosis records). Lung cancer deaths occurring up to 2012 were identified using Office of National Statistics mortality data and the association between metformin use (before and after diagnosis) and risk of lung cancer-specific mortality was calculated using Cox regression models. In analysis of 533 patients, we found a weak non-significant reduction in lung cancer-specific mortality with metformin use after diagnosis (adjusted HR, 0.86; 95% CI, 0.68–1.09). No association was evident for metformin use before diagnosis and cancer-specific mortality in analysis of 1350 patients (adjusted HR, 0.97; 95% CI, 0.86, 1.11). Associations were similar by duration of use. In addition, after adjustment for potential confounders, there was little evidence of an association between the use of other anti-diabetic medications (either before or after diagnosis) and lung cancer-specific mortality; including sulfonylureas, insulin or other anti-diabetic medications (such as thiazolidinediones). Overall, the results from this population-based study provide little evidence of a protective association between metformin use and cancer mortality in lung cancer patients.

Low-dose aspirin and survival from lung cancer: a population-based cohort study.

BackgroundPreclinical evidence suggests that aspirin may inhibit lung cancer progression. In a large cohort of lung cancer patients, we investigated whether low-dose aspirin use was associated with a reduction in the risk of lung cancer-specific mortality.MethodsWe identified lung cancer patients from English cancer registries diagnosed between 1998 to 2009 from the National Cancer Data Repository. Medication usage was obtained from linkages to the UK Clinical Practice Research Datalink and lung cancer-specific deaths were identified from Office of National Statistics mortality data. Hazard ratios (HR) and 95 % confidence intervals (CI) for the association between low-dose aspirin use (before and after diagnosis) and risk of lung cancer-specific mortality were calculated using Cox regression models.ResultsA total of 14,735 lung cancer patients were identified during the study period. In analysis of 3,635 lung cancer patients, there was no suggestion of an association between low-dose aspirin use after diagnosis and cancer-specific mortality (adjusted HR = 0.96, 95 % CI: 0.85, 1.09). Similarly, no association was evident for low-dose aspirin use before diagnosis and cancer-specific mortality (adjusted HR = 1.00, 95 % CI: 0.95, 1.05). Associations were comparable by duration of use and for all-cause mortality.ConclusionOverall, we found little evidence of a protective association between low-dose aspirin use and cancer-specific mortality in a large population-based lung cancer cohort.

Survival patterns in teenagers and young adults with cancer in the United Kingdom: Comparisons with younger and older age groups

AimsWe aimed to describe and compare survival in teenagers and young adults (TYAs) with cancer to that of younger children and older adults, to identify sub-populations at greater or lesser risk of death. MethodsWe compared survival in cancer patients diagnosed in the United Kingdom aged 13–24years (TYAs) to those aged 0–12 (children) and 25–49years (adults) using the National Cancer Data Repository. All cases had a first cancer diagnosis between 1st January 2001 and 31st December 2005 with censor date 31st December 2010 or death if earlier. ResultsWe found six distinct statistically significant survival patterns. In pattern 1, the younger the age-group the better the 1- and 5-year survival (acute lymphoid leukaemia, carcinoma of ovary and melanoma). In pattern 2, TYAs had a worse 5-year survival than both children and young adults (bone and soft tissues sarcomas). In pattern 3, TYAs had a worse 1-year survival but no difference at 5-years (carcinoma of cervix and female breast). In pattern 4, TYAs had better 1-year survival than adults, but no difference at 5years (carcinoma of liver and intrahepatic bile ducts, germ cell tumours of extra-gonadal sites). In pattern 5, the younger the age-group the better the 5-year survival, but the difference developed after 1-year (acute myeloid leukaemia, carcinoma of colon and rectum). In pattern 6, there was no difference in 1- and 5-year survival between TYAs and adults (testicular germ cell tumours, ovarian germ cell tumours and carcinoma of thyroid). ConclusionTYAs with specific cancer diagnoses can be grouped according to 1- and 5-year survival patterns compared to children and young adults. To further improve survival for TYAs, age-specific biology, pharmacology, proteomics, genomics, clinician and patient behaviour studies embedded within clinical trials are required.

The impact of socio-economic deprivation on incidence, treatment and mortality from prostate cancer in England, 1990–2010

Objective: To explore any association between socio-economic deprivation and prostate cancer diagnosis and/or treatment. Patients and methods: Data was extracted as follows: We gained the incident cases and staging from the National Cancer Data Repository, survival from the Cancer Information System, mortality from the Office for National Statistics, treatment data from Hospital Episode Statistics and National Clinical Analysis and Specialised Applications Team. Our analysis regarding socio-economic deprivation was controlled for age distribution. Results: We recorded 518,453 diagnoses of prostate cancer; 174,579 prostate cancer deaths; 33,889 prostatectomies and 21,351 radiotherapy treatments. Incidence is increasing in all groups, but the highest is amongst the least deprived. Mortality is decreasing, with survival consistently better in the least deprived. Prostatectomies are more frequent in the least deprived; however, this gap is narrowing. Conclusions: Prostate cancer incidence, survival and treatment are associated with socio-economic deprivation. Prostatectomy rates show a decrease in the gap of inequality. Multiple potential confounding factors, such as rates of prostate specific antigen (PSA) testing and access to health care are associated with socio-economic deprivation. The unifying influences of Improving Outcomes Guidance and the National Treatment Guidelines are intended to counteract the above inequalities. Particularly in prostate cancer, where long-term gain depends on multiple factors, individualised treatment decisions are paramount.

The Effect of the UK Coordinating Centre for Cancer Research Anal Cancer Trial (ACT1) on Population-based Treatment and Survival for Squamous Cell Cancer of the Anus

Between 1987 and 1994, three randomised phase III trials showed that chemoradiotherapy with mitomycin C and 5-fluorouracil was superior to radiotherapy alone (ACT1, European Organization for Research and Treatment of Cancer) or radiotherapy with 5-fluorouracil (Radiation Therapy Oncology Group 87-04, Eastern Cooperative Oncology Group 1289) for squamous cell carcinoma of the anus. We explored the population-based changes in England before, during and after the UK-based ACT1 trial. Information was extracted from the National Cancer Data Repository on patients diagnosed with squamous cell anal cancer in England between 1981 and 2010 (n = 11 743). Robust treatment information was available for the Yorkshire region (n = 1065). Changes in treatment patterns and 3 year survival were investigated in 7 year cohorts before, during and after the ACT1 trial. In Yorkshire, the proportion of patients receiving surgery alone fell from 61.6% before, 29.8% during and 12.5% after ACT1; the proportion of patients receiving primary chemoradiotherapy rose from 6.5% before, 17.7% during and 58.8% after ACT1 and continued to rise to 70.3% in the subsequent period. Three year survival improved during the study period from 59.5% (95% confidence interval 56.6–62.2) before ACT1 to 73.6% (95% confidence interval 71.9–75.2) after the trial. Survival in Yorkshire was comparable with that in England. The treatment for squamous cell carcinoma of the anus changed dramatically during the study period. The predominant use of surgery before ACT1, a transition phase during the trial and a dramatic increase in the use of chemoradiotherapy after ACT1 provide strong evidence of the effect of the trial on population-based practice. Survival continued to increase during this period.

PWE-318 Emergency admission and short term outcomes in english colorectal cancer patients 1998–2010

<h3>Introduction</h3> English colorectal cancer (CRC) outcomes are inferior to those of similar income level European countries. England has a ‘stubbornly high’ rate of emergency admission. Identifying where risk of emergency admission is greatest and outcomes of treatment poor, may help target interventions and allow the spread of best practice. <h3>Method</h3> Individuals with a first primary diagnosis of colorectal cancer treated between 1998 and 2010 within the English NHS were identified from the National Cancer Data Repository. Numbers of emergency admissions and short term outcomes (mortality at 30- and 90- days) for those undergoing major or minor resection, bypass, stoma or stent were compared. <h3>Results</h3> 353,892 individuals were identified, of which 248,655 (70.3%) presented electively and 105,237 (29.7%) presented as an emergency. The proportion of patients presenting as an emergency fell over the study period (32.6% of admissions in 1998, 25.3% in 2010), with emergency patients being more likely to be female, older (≥80years), to have colon cancer, an advanced stage of disease, more co-morbidity and to come from a socioeconomically deprived background. There was wide variation in the numbers of patients admitted as an emergency by hospital trust and in rates of early mortality. Variation in emergency admission rate did not fully account for the significant difference in post-operative mortality between hospital trusts. <h3>Conclusion</h3> Comparison of outcomes at a population level allows patterns of disease and trends in its management to be highlighted. It is well known that emergency colorectal cancer patients tend to be older, with more advanced disease, but the finding that emergencies as a proportion of CRC admissions are falling may suggest that recent efforts to reduce emergency admissions (e.g. screening) may be having an impact. The variability in emergency admission rates and rates of early mortality suggests that local factors may heavily influence outcomes, but that high performing trusts may have policies and procedures which could be of benefit to others in the management of the emergency CRC patient. <h3>Disclosure of interest</h3> None Declared.

PTU-193 Wide variation in the use of radiotherapy in the management of surgically treated rectal cancer across the english NHS

Introduction Radiotherapy is an important treatment modality in the multidisciplinary management of rectal cancer. It is delivered both in the neo-adjuvant setting and postoperatively but, whilst it reduces local recurrence, it does not influence overall survival and increases the risk of long-term complications. This has led to a variety of international practice patterns. This variation can have significant impact on commissioning but also future clinical research. This study explores its use within the large English National Health Service (NHS). Method Information on all individuals diagnosed with a surgically treated rectal cancer between the April 2009 and December 2010 were extracted from the Radiotherapy Dataset (RTDS) linked to the National Cancer Data Repository (NCDR). Individuals were grouped into those receiving no radiotherapy (NRT), short-course radiotherapy with immediate surgery (SCRT-I), short-course radiotherapy with delayed surgery (SCRT-D), long-course chemoradiotherapy (LCCRT), other radiotherapy (ORT) and post-operative radiotherapy (PORT). Patterns of use were then investigated. Results The study consisted of 9,201 individuals; 4,538 (49.3%) received some form of radiotherapy. SCRT-I was used in 12.3%, SCRT-D in 3.7%, LCCRT in 26.5%, ORT in 5.0% and PORT in 2.2%. Radiotherapy was used more commonly in men and in those receiving abdominoperineal excision and less commonly in the elderly and those with co-morbidity. Significant and substantial variations were also seen in its use across all the multidisciplinary teams managing this disease with the proportion of any radiotherapy use ranging from 5.1% to 77.8% of surgically treated rectal cancer patients treated in each of the MDTs managing the disease across England. Conclusion Wide variation exists in both the use of and type of radiotherapy delivered in the management of rectal cancer across the English NHS. Prospective population-based collection of local recurrence and patient-reported late toxicity information are required to further improve patient selection for preoperative radiotherapy. Disclosure of interest None Declared.

Incidence and survival of gynecologic sarcomas in England.

Gynecologic sarcomas account for approximately 3% to 4% of all gynecologic malignancies and are associated with poor outcomes compared with gynecologic carcinomas. The aim of this study is to report the incidence and survival rates of the main gynecologic sarcomas using national English cancer registration data. Records of gynecologic sarcomas diagnosed between 1985 and 2008 were extracted from the English National Cancer Data Repository. ICD-O3 morphology codes were used to assign tumor records to specific histologic subgroups. Incidence and 5-year relative survival rates were calculated. There were 5316 new cases of gynecologic sarcoma diagnosed in England between 1985 and 2008. Incidence rates increased significantly in the early 1990s, probably due to coding changes. Age-specific incidence rates were highest in women aged between 45 and 64 years. In the most recent period studied (2001-2008), incidence rates fluctuated between 8 and 9.6 per million. The most common anatomical site was the uterus (83% of all diagnoses), and the most common histologic diagnosis was leiomyosarcoma (52% of all diagnoses). Overall 5-year relative survival increased significantly between 1985-1989 and 2000-2004, from 34% to 48%. Gynecologic sarcoma incidence rates have varied little since 1993, whereas survival has improved significantly. These results are consistent with previously published small series and case studies, and provide a more complete picture of gynecologic sarcoma incidence and survival patterns in England.