Problem addressed, background and strategic significance

Rectal cancer is common in the UK with around 14,000 people being diagnosed each year. Up to one in ten of these people will have disease which has spread beyond the wall of the bowel (locally advanced rectal cancer). In addition, one in ten patients who have an operation for rectal cancer will have their cancer return within the pelvis in the future (locally recurrent rectal cancer). The treatment for locally advanced and recurrent rectal cancer can involve a combination of surgery, chemotherapy and radiotherapy. These services are not available at every hospital in the UK and sometimes people may receive treatment at a different hospital from which they were diagnosed. This work will identify the way in which treatment decisions are made by specialists who deal with patients with complex rectal cancer and to link these decisions to clinical and survival outcomes.

Method(s) used

This study will be performed in three phases. The first phase will involve a survey to identify the current available services for patients with locally advanced and recurrent rectal cancer across the UK. The second will compare how the treatment of patients diagnosed with LARC and LRRC compares to national guidelines. The third will focus on the hospitals who perform surgery on patients with complex rectal cancer and collect data on what surgery is provided. By using information collected in established national datasets we will be able to look at longer term outcome.

All adult patients with a new diagnosis of LARC and LRRC will be eligible for inclusion. These patients will be identified through MDT meeting records. An online data capture system will be used to record a patient’s clinical details and will be linked to routinely collected, national data.

Hoped for results of this research

We hope that this research will provide a resource for patients, clinicians and commissioners by mapping rectal cancer services throughout the UK. In addition, establishing current practice is a vital component in moves to improve adherence to guidelines and highlight any deficiencies in services provided.

What is this research is expected to add to the knowledge of bowel disease and what is the impact you hope to achieve for patients?

This work will be performed as part of the Improving Management for Patients with Advanced Colorectal Tumour (IMPACT) programme. The ultimate aim of this programme and the proposed study is to increase the number of patients with LARC and LRRC referred to appropriate referral centres and to increase the survival rate.