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Journal of Public Health Advance Access published online on December 20, 2007
Journal of Public Health, doi:10.1093/pubmed/fdm081
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© The Author 2007, Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved
The online version of this article has been published under an open access model.

Is the performance of cancer services influenced more by hospital factors or by specialization?


Mark McCarthy1,
Preeti Datta1
Chris Sherlaw-Johnson1
Michel Coleman2
Bernard Rachet2

1 Department of Epidemiology and Public Health, University College London, 1–19 Torrington Place, London WC1E 6BT, UK
2 London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK


Address correspondence to Mark McCarthy, E-mail: m.mccarthy{at}ucl.ac.uk


  Abstract

The Cancer Plan for England, introduced in 2000, has promoted cancer service specialization. We have investigated how far specialization and general hospital factors each contributed to service performance for four common cancers—breast, colorectal, lung and prostate—at the time of the Cancer Plan.

Performance measures of service standards, waiting time to treatment, satisfaction with care, in-hospital mortality and population-level survival were identified from secondary data sets for 167 acute hospitals and 34 cancer networks in England. We correlated rankings of networks and hospitals between the data sets using non-parametric statistics. At cancer network level, peer-review service standards were associated (P < 0.05) with 1-year survival for colorectal and lung cancers, and waiting times for lung cancer. At hospital level, standards were associated (P < 0.01) with waiting time to treatment for breast and colorectal cancers. However, there were stronger associations between specializations within hospitals: rankings of breast, colorectal and prostate cancers were highly associated (P < 0.001) for 5-year survival, patient satisfaction, standards and in-hospital mortality. Hospital-level differences appear to contribute more to variations in cancer performance than specialization differences within hospitals. The findings may be used for planning and commissioning better cancer services.

Keywords: cancer services, hospital, management, performance, planning, specialization


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