Khachatryan, A.; (2008) The use of routine data to investigate hospital-level determinants of colorectal cancer survival in London. Doctoral thesis , University of London.

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Abstract

Objective: Colorectal cancer survival varies at individual level and also geographically. This study used secondary data to investigate whether hospital organisational factors may explain colorectal cancer survival.;Methods: For 28 acute hospitals treating colorectal cancer in London, data on 15 468 patients first treated between 1996 and 2001 were drawn from the Thames Cancer Registry and their 5-year relative survival was calculated, with standard errors adjusted for clustering. The literature was examined to identify potential hospital organisational predictors of survival. Four English national data sets including measures of hospital organisation were identified and assessed for quality using a standardised method (Directory of Clinical Databases, DoCDat). Variables were assembled relating to the years 2000-2001. A multivariate relative survival model was used to investigate cross-sectional associations between the organisational measures and survival. Effects of missing data were also examined statistically.;Results: The data sets were assessed as of sufficient quality for the study. Most data by hospital were over 80% complete. Missing values for tumour stage and lack of detailed treatment information were the main limitations of the cancer registry data. Hospital organisational variables examined included hospital volume, staffing, waiting times, cancer services standards, and type (teaching/non-teaching). Individual factors in the model included age, sex, deprivation index and stage, but comorbidity could not be tested. There was a significant survival gradient across the hospitals, both before and after adjustment for individual factors. No relationship was found between survival and hospital volume, medical or nurse staffing, or waiting times for referral assessment. However, significant associations were found for teaching status, and for four of the cancer standards.;Discussion: Interpretation is limited by the cross-sectional design, temporal relationships, missing data and the limited number of hospitals. However, the study shows the potential of using hospital datasets to investigate organisational factors in cancer survival, and indicates the possible impact of teaching hospital status and some measures of cancer standards on survival. Further research is indicated to confirm these associations and investigate pathways for the effects.

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