Journal Article

High hospital research participation and improved colorectal cancer survival outcomes: a population-based study

Kaplan, Richard, Finan, Paul J, Stephens, Richard, Gregory, Walter, Sebag-Montefiore, David, Seymour, Matt, Thomas, James D, Campbell, Helen, Cameron, David, Chapman, Michael, Parmar, Mahesh, Hamilton, Russell, Selby, Peter, Downing, Amy, Corrigan, Neil, Morris, Eva JA

2017

Overview

ObjectiveIn 2001, the National Institute for Health Research Cancer Research Network (NCRN) was established, leading to a rapid increase in clinical research activity across the English NHS. Using colorectal cancer (CRC) as an example, we test the hypothesis that high, sustained hospital-level participation in interventional clinical trials improves outcomes for all patients with CRC managed in those research-intensive hospitals.DesignData for patients diagnosed with CRC in England in 2001–2008 (n=209 968) were linked with data on accrual to NCRN CRC studies (n=30 998). Hospital Trusts were categorised by the proportion of patients accrued to interventional studies annually. Multivariable models investigated the relationship between 30-day postoperative mortality and 5-year survival and the level and duration of study participation.ResultsMost of the Trusts achieving high participation were district general hospitals and the effects were not limited to cancer ‘centres of excellence’, although such centres do make substantial contributions. Patients treated in Trusts with high research participation (≥16%) in their year of diagnosis had lower postoperative mortality (p<0.001) and improved survival (p<0.001) after adjustment for casemix and hospital-level variables. The effects increased with sustained research participation, with a reduction in postoperative mortality of 1.5% (6.5%–5%, p<2.2×10−6) and an improvement in survival (p<10−19; 5-year difference: 3.8% (41.0%–44.8%)) comparing high participation for ≥4 years with 0 years.ConclusionsThere is a strong independent association between survival and participation in interventional clinical studies for all patients with CRC treated in the hospital study participants. Improvement precedes and increases with the level and years of sustained participation.

• Publisher: BMJ Publishing Group LTD,BMJ Publishing Group
• Subject: Aged / Aged, 80 and over / Biomedical Research - statistics & numerical data / Clinical Trials as Topic - statistics & numerical data / Colon / Colorectal cancer / Colorectal Neoplasms - mortality / Colorectal Neoplasms - surgery / England / Female / Health risk assessment / Hospitals - statistics & numerical data / Humans / Male / Medical research / Middle Aged / Mortality / Ovarian cancer / Postoperative Period / Risk Adjustment / State Medicine / Survival Rate / Time Factors / Treatment Outcome