TRENDS IN COLORECTAL-CANCER CARE IN SOUTHERN ENGLAND, 1989-1993 - USING HES DATA TO INFORM CANCER SERVICES REVIEWS

Background-This paper describes trends in hospital activity, hospital admissions, and treatments for colorectal cancer on residents of the S outh Thames regions (population 8 million) between 1989-1993 against t he background of the Calman Report on the future of cancer services in England and Wales. Methods-The analyses are derived from UK hospital data, which are collected as finished consultant episodes (FCEs). Thes e are defined as episodes ''where a patient has completed a period of care under a consultant and is either transferred to another consultan t or is discharged.'' Probability matching was used to derive patient- based records, matching FCEs to admissions. A total of 18 542 South Th ames residents aged 40-99 were admitted for colorectal cancer between 1 January 1989 and 31 December 1993. Time trends were analysed for pro cedures, FCEs, admissions, and patient numbers by admission type (ordi nary admissions and day case admissions). Results-Between 1989 and 199 3 inclusive colorectal cancer admissions doubled (98% increase p (tren d) < 0.0001). These admissions were a result of a 6.4-fold increase in day case admissions and a 41% increase in ordinary admissions. The pr oportion of patients having a day case admission rose from 9% in 1989 to 18% in 1993 (p < 0.0001). Overall, 2894 (16%) patients had a day ca se admission; 1894 of these (65%) were also admitted as ordinary admis sions. The number of FCEs and admissions per patient rose from 1.37 an d 1.28 respectively in 1989 to 2.09 and 1.99 respectively in 1993. FCE s were between 5% and 8% higher than admissions over the five years. T he number of ordinary (that is, overnight) inpatient admissions per pa tient rose from 1.23 to 1.41 over the five year period and day case in patient admissions from 1.25 to 3.45. Chemotherapy accounted for 50% o f the rise in day case admissions; colonoscopy and sigmoidoscopy were associated with a further 18%. Fourteen per cent of the increase in or dinary admissions was also because of chemotherapy. Conclusion-The mon itoring of site specific trends in admission, treatments, and procedur es on a population basis should he a core requirement of health author ities to inform needs assessment, resource allocation, and service pla nning. The rise in admissions and chemotherapy treatments have implica tions for drug costs, laboratory and inpatient services, monitoring, a nd clinical audit.