Morris E, Haward R A, Gilthorpe M S, Craigs C, Forman D
Cancer Epidemiology Group, Centre for Epidemiology and Biostatistics, The University of Leeds, Arthington House, Cookridge Hospital, Leeds LS16 6QB, UK.
Br J Cancer. 2006 Oct 23;95(8):979-85. doi: 10.1038/sj.bjc.6603372.
The 1995 Calman-Hine plan outlined radical reform of the UK's cancer services with the aim of improving outcomes and reducing inequalities in NHS cancer care. Its main recommendation was to concentrate care into the hands of site-specialist, multi-disciplinary teams. This study aimed to determine if the implementation of Calman-Hine cancer teams was associated with improved processes and outcomes of care for colorectal cancer patients. The design included longitudinal survey of 13 colorectal cancer teams in Yorkshire and retrospective study of population-based data collected by the Northern and Yorkshire Cancer Registry and Information Service. The population was all colorectal cancer patients diagnosed and treated in Yorkshire between 1995 and 2000. The main outcome measures were: variations in the use of anterior resection and preoperative radiotherapy in rectal cancer, chemotherapy in Dukes stage C and D patients, and five-year survival. Using multilevel models, these outcomes were assessed in relation to measures of the extent of Calman-Hine implementation throughout the study period, namely: (i) each team's degree of adherence to the Manual of Cancer Service Standards (which outlines the specification of the 'ideal' colorectal cancer team) and (ii) the extent of site specialisation of each team's surgeons. Variation was observed in the extent to which the colorectal cancer teams in Yorkshire had conformed to the Calman-Hine recommendations. An increase in surgical site specialisation was associated with increased use of preoperative radiotherapy (OR=1.43, 95% CI=1.04-1.98, P<0.04) and anterior resection (OR=1.43, 95% CI=1.16-1.76, P<0.01) in rectal cancer patients. Increases in adherence to the Manual of Cancer Service Standards was associated with improved five-year survival after adjustment for the casemix factors of age, stage of disease, socioeconomic status and year of diagnosis, especially for colon cancer (HR=0.97, 95% CI=0.94-0.99 P<0.01). There was a similar trend of improved survival in relation to increased surgical site specialisation for rectal cancer, although the effect was not statistically significant (HR=0.93, 95% CI=0.84-1.03, P=0.15). In conclusion, the extent of implementation of the Calman-Hine report has been variable and its recommendations are associated with improvements in processes and outcomes of care for colorectal cancer patients.
1995年的卡尔曼-海恩计划概述了英国癌症服务的彻底改革，旨在改善治疗效果并减少国民保健制度癌症护理中的不平等现象。其主要建议是将护理工作集中到专科、多学科团队手中。本研究旨在确定卡尔曼-海恩癌症团队的实施是否与改善结直肠癌患者的护理流程和治疗效果相关。研究设计包括对约克郡13个结直肠癌团队的纵向调查，以及对由北部和约克郡癌症登记与信息服务中心收集的基于人群的数据进行回顾性研究。研究对象为1995年至2000年期间在约克郡被诊断和治疗的所有结直肠癌患者。主要结局指标包括：直肠癌患者前切除术和术前放疗的使用差异、Dukes C期和D期患者的化疗情况以及五年生存率。使用多水平模型，根据整个研究期间卡尔曼-海恩实施程度的指标对这些结局进行评估，这些指标分别为：（i）每个团队对《癌症服务标准手册》（其中概述了“理想”结直肠癌团队的规范）的遵守程度，以及（ii）每个团队外科医生的专科化程度。观察到约克郡的结直肠癌团队在符合卡尔曼-海恩建议的程度上存在差异。外科专科化程度的提高与直肠癌患者术前放疗的使用增加（比值比=1.43，95%置信区间=1.04-1.98，P<0.04）和前切除术的使用增加（比值比=1.43，95%置信区间=1.16-1.76，P<0.01）相关。在对年龄、疾病分期、社会经济地位和诊断年份等病例组合因素进行调整后，对《癌症服务标准手册》的遵守程度提高与五年生存率的改善相关，尤其是结肠癌（风险比=0.97，95%置信区间=0.94-0.99，P<0.01）。直肠癌患者的生存率也有随着外科专科化程度提高而改善的类似趋势，尽管该效应在统计学上不显著（风险比=0.93，95%置信区间=0.84-1.03，P=0.15）。总之，卡尔曼-海恩报告的实施程度各不相同，其建议与结直肠癌患者护理流程和治疗效果的改善相关。
