Authors' objectives:

To summarise the research evidence which informed the Department of Health's Clinical Outcomes Group's guidance on commissioning cancer services, based on a series of systematic reviews.

Authors' results and conclusions: Quality of diagnostic procedures should be monitored, particularly the completeness of the examination of all of the large bowel using colonoscopy, and associated complications. Training should be given, if necessary, to improve standards. Substantial variability in outcomes achieved by surgeons suggests that concentrating surgery in the hands of those with better results could improve survival. Histopathologists should provide detailed information on the nature and extent of the cancer and give feedback to surgeons. Surgeons should aim, wherever possible, to use operations which conserve the anal sphincter and avoid the need for a stoma. Pre-operative radiotherapy should be routinely offered to patients with rectal cancer unless surgeons demonstrate low (<10%) local recurrence rates. Chemotherapy can be beneficial in more advanced cancers but agents other than 5-FU+ folinic acid (FUFA) should not be used outside the context of trials until their benefits have been clearly established. There is no evidence that routine intensive follow-up after primary treatment benefits patients. Reducing the intensity of follow-up could conserve NHS resources without compromising quality.

Authors' recommendations: Colorectal (bowel) cancer is the second most common cause of cancer death in the UK. The disease is curable when not too far advanced and UK survival rates could be substantially improved with better management.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.york.ac.uk/inst/crd/ehcb.htm

Year Published: 1998

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: England

Organisation Name: University of York

Contact Address: University of York, York, Y01 5DD, United Kingdom. Tel: +44 1904 321040, Fax: +44 1904 321041,

Contact Name: crd@york.ac.uk

Contact Email: crd@york.ac.uk

Copyright: Centre for Reviews and Dissemination