Bowel cancer patients whose disease has spread to the liver are not being referred to specialists for potentially life-saving surgery, according to research published in the British Journal of Surgery.
“This shows how important it is for cancer specialists to collaborate when discussing treatment so all patients can benefit from their collective medical expertise.” – Professor Peter Johnson, Cancer Research UK’s chief clinician
More than 40,000 people are diagnosed with bowel cancer every year and the disease spreads to the liver in around half of all cases. But this Cancer Research UK led study, which looked at rates of liver surgery in Yorkshire, found that only a fifth of patients were being referred to liver specialists.
Referral rates also varied widely between the seven hospitals in the area. While one hospital referred as many as 43 per cent of patients on to see liver specialists, another referred as few as 13 per cent.
Researchers at St James’s University Hospital, Leeds, looked at the treatment of more than 600 patients with bowel cancer that had spread to the liver. Around one in five were referred to liver specialists and, of these patients, three quarters were deemed to be fit for liver surgery.
Patients who the bowel specialists decided shouldn’t undergo a liver operation, despite being fit for surgery, were reassessed by the liver specialists using the same information. In 44 per cent of cases the liver specialists disagreed1.
All patients are seen by bowel cancer specialists, who can refer them to liver specialists if they think they might benefit from liver treatment. The most common treatment is surgery to remove any tumours from the liver – which may help cure the patient2.
Mr Alastair Young, study author and surgical registrar based at St James’s University Hospital, said: “Bowel cancer specialists are deciding whether or not a patient is suitable for liver surgery. And we’re seeing liver specialists disagree with the decision in almost half of cases, meaning that some patients are denied an operation that could save their lives.
“One of the striking things about this work is that our region has been shown to have the highest rates in the country of liver surgery for bowel cancer patients. But we’ve shown a significant gap between current and best practice in our region, suggesting there is plenty of room for improvement up and down the country.
“These decisions are not made lightly but liver and bowel specialists need to talk to each other much more to ensure every patient has the best possible chance of beating the disease and to reduce the worrying difference in referral rates.”
Professor Peter Johnson, Cancer Research UK’s chief clinician, said: “This shows how important it is for cancer specialists to collaborate when discussing treatment so all patients can benefit from their collective medical expertise.
“The patient’s welfare is key so the benefits of surgery must be weighed against the risks. Not all patients will be eligible for these operations because their cancer may be too advanced, they may have other health problems or they may not want to have surgery.”
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Young, A. L., et al, Variation in referral practice for patients with colorectal cancer liver metastases British Journal of Surgery, 2013 DOI: 10.1002/bjs.9285
1 The liver specialists deemed 29 per cent to be operable and 15 per cent to warrant further assessment.
2 There have been significant advances in indications and outcomes for liver surgery for patients with bowel cancer. Between 40-60 per cent of patients will survive for at least 5 years following surgery and around 25 per cent survive 10 years or more. The safety of these operations has also improved, with mortality rates lower than two per cent.