The impact of the Calman-Hine report: analysis of breast and colorectal cancer surgical workloads and the degree of surgical site specialization in the Yorkshire region of the UK, 1990-2000

Abstract

The 1995 Calman-Hine report set out the first overall cancer policy for England and Wales, with the aim of improving the quality of care offered to cancer patients. One of its key recommendations was to concentrate cancer care in the hands of site-specialist doctors. This retrospective population-based study aimed to determine whether this recommendation has been implemented across the Yorkshire region of the UK (population 3.6 million) for breast and colorectal cancer surgery. Information on all breast and colorectal cancer patients diagnosed between 1990 and 2000 within the former Yorkshire Regional Health Authority of the UK was obtained from the Northern and Yorkshire Cancer Registry and Information Service. The annual median workloads of each surgeon operating on these patients, in terms of breast and/or colorectal cancer, were calculated. Each surgeon was categorized as either specialist or non-specialist based on his or her self-stated interests or workload. The proportion of breast and colorectal patients in each Trust and in each year receiving surgery from a site specialist was calculated to determine the extent of surgical site specialization. The distribution of surgeons' workloads in breast and colorectal cancer surgery was also examined across three time periods; 1990-93, 1994-97 and 1998-2000. There has been a major shift towards surgical site specialization in breast and colorectal cancer care across Yorkshire. The effect was more marked in breast cancer than in colorectal cancer. The degree of surgical site specialization varied considerably across hospital Trusts. In both cancer sites, the move towards surgical site specialization began prior to the publication of the Calman-Hine report.