RT Journal Article
SR Electronic
T1 High hospital research participation and improved colorectal cancer survival outcomes: a population-based study
JF Gut
JO Gut
FD BMJ Publishing Group Ltd and British Society of Gastroenterology
SP 89
OP 96
DO 10.1136/gutjnl-2015-311308
VO 66
IS 1
A1 Amy Downing
A1 Eva JA Morris
A1 Neil Corrigan
A1 David Sebag-Montefiore
A1 Paul J Finan
A1 James D Thomas
A1 Michael Chapman
A1 Russell Hamilton
A1 Helen Campbell
A1 David Cameron
A1 Richard Kaplan
A1 Mahesh Parmar
A1 Richard Stephens
A1 Matt Seymour
A1 Walter Gregory
A1 Peter Selby
YR 2017
UL http://gut.bmj.com/content/66/1/89.abstract
AB Objective In 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.Design Data 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.Results Most 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.Conclusions There 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.