603P - Improving clinical outcomes in cancer care through centralisation of treatment and clinical audit: The rectal cancer case

Date 29 September 2014
Event ESMO 2014
Session Poster Display session
Topics Bioethics, Legal, and Economic Issues
Colon and Rectal Cancer
Presenter Josep Borras
Citation Annals of Oncology (2014) 25 (suppl_4): iv167-iv209. 10.1093/annonc/mdu333
Authors J.M. Borras1, P. Manchon-Walsh2, J. Prades2, L. Aliste2, J.A. Espinas2, A. Guarga3
  • 1Cancer Strategy, Department of Health, 08908 - Barcelona/ES
  • 2Cancer Strategy, Department of Health, Barcelona/ES
  • 3Health Service Procurement & Assessment, Catalonian Health Service, Barcelona/ES



Using the clinical audit as a quality improvement tool with evidence of better results in high-volume centres in Catalonia (Spain), a re-organisation of specialized surgical procedures and rare tumour distribution among reference hospitals was implemented. Using rectal cancer as a case study, we assess the impact of centralization of high-complexity cancer care services.


Mixed methods combining quantitative and qualitative data were used. Quality of cancer care in rectal cancer was audited in accordance with the clinical practice guideline (CPG), and outcomes in all patients surgically treated for the first time in public hospitals in Catalonia in two-time periods (2005/7 and 2011/12) were assessed. Indicators of the quality of rectal cancer care and its results, comparing both periods, were analysed in order to measure the impact of centralization. In addition, key informant semi-structured interviews (n = 15) were undertaken with the managers and the lead clinicians involved in the process, to obtain their perception of this re-organisation.


From 2005/7 to 2011/12 the number of hospitals performing rectal cancer surgery decreased from 51 to 29 centres. A better quality of TME (36.2% vs 79.6%), more preoperative radio-chemotherapy (51% vs 65.8%) and more lymph node extractions (median: 10 vs 14 n.) were observed comparing both periods. Also, the rate of LR during the first year after surgery fell from 3.49 to 2.75/100.000. Qualitative assessment showed a favourable stance towards centralisation among the stakeholders involved, although critical views arose in regard to a surgery-centred concentration, the takeover of the diagnostic process by the referring center including the associated costs, and the lack of policy guidance in respect of continuity of care.


Health policy approach combining assessment from the clinical audit with reorganisation of the delivery of complex treatments has been associated with better outcomes. A model of care based on the centralisation of high-complexity cancer treatments should be reinforced by managed regional networks and improved referral of patients.


All authors have declared no conflicts of interest.