Cost-Utility Analysis of Major System Change in Specialist Cancer Surgery in London, England, Using Linked Patient-Level Electronic Health Records and Difference-in-Differences Analysis.

Background: Studies have shown that centralising surgical treatment for some cancers can improve patient outcomes, but there is limited evidence of the impact on costs or health-related quality of life.

Objectives: We report the results of a cost-utility analysis of the RESPECT-21 study using difference-in-differences, which investigated the reconfiguration of specialist surgery services for four cancers in an area of London, compared to the Rest of England (ROE).

Methods: Electronic health records data were obtained from the National Cancer Registration and Analysis Service for patients diagnosed with one of the four cancers of interest between 2012 and 2017.

"Attending to History" in Major System Change in Healthcare in England: Specialist Cancer Surgery Service Reconfiguration.

Background: The reconfiguration of specialist hospital services, with service provision concentrated in a reduced number of sites, is one example of major system change (MSC) for which there is evidence of improved patient outcomes. This paper explores the reconfiguration of specialist oesophago-gastric (OG) cancer surgery services in a large urban area of England (Greater Manchester, GM), with a focus on the role of history in this change process and how reconfiguration was achieved after previous failed attempts.

Methods: This study draws on qualitative research from a mixed-methods evaluation of the reconfiguration of specialist cancer surgery services in GM.

Transforming cancer outcomes in England: earlier and faster diagnoses, pathways to success, and empowering alliances.

Cancer outcomes and patient experience in England have never been better but survival remains worse than in comparable countries. Differences in stage at diagnosis and, to a lesser extent, access to optimal treatments are likely to be the most important factors. The national cancer plan emphasizes earlier and faster diagnosis and the creation of cancer alliances providing strategic leadership and coordination.

Variation in the prevalence of urinary catheters: a profile of National Health Service patients in England.

Introduction: Harm from catheter-associated urinary tract infections is a common, potentially avoidable, healthcare complication. Variation in catheter prevalence may exist and provide opportunity for reducing harm, yet to date is poorly understood. This study aimed to determine variation in the prevalence of urinary catheters between patient groups, settings, specialities and over time.

Reorganising specialist cancer surgery for the twenty-first century: a mixed methods evaluation (RESPECT-21).

Background: There are longstanding recommendations to centralise specialist healthcare services, citing the potential to reduce variations in care and improve patient outcomes. Current activity to centralise specialist cancer surgical services in two areas of England provides an opportunity to study the planning, implementation and outcomes of such changes. London Cancer and Manchester Cancer are centralising specialist surgical pathways for prostate, bladder, renal, and oesophago-gastric cancers, so that these services are provided in fewer hospitals.

The increased rate of prostate specific antigen testing has not affected prostate cancer presentation in an inner city population in the UK.

Objective: To assess whether the increased use of prostate-specific antigen (PSA) testing over the last 15 years has changed the way prostate cancer presents in an inner city UK population, where PSA screening rates might be expected to be lower than in epidemiological studies based in North America, where there is a significant tendency to a localized stage and earlier age at diagnosis.

Patients And Methods: The study comprised a 5-year retrospective and 5-year prospective analysis of data on 704 men diagnosed with prostate cancer over the 10-year period since the introduction of PSA testing (1994-2003).

Results: The median (range) age at presentation remained unchanged, at 72 (45-94) years; the PSA level at diagnosis was 20-46 microg/L, with a steady decline after 1997.

Impact of socioeconomic status on bladder cancer outcome.

Purpose Of Review: To give an update on the possible influence of socioeconomic status on bladder cancer outcome.

Recent Findings: Research to investigate the impact of socioeconomic status on bladder cancer outcome has increased during the past 2 years. The findings of these studies show that socioeconomic status is a significant predictor of survival in male and female patients presenting with bladder cancer, when death from all causes is considered.

Collagen secretion after photodynamic therapy versus scar-inducing anti-cancer modalities: an in vitro study.

Photodynamic therapy (PDT) has been associated anecdotally with good quality healing and an absence of scar formation. Our previous studies, examining the levels of the collagen specific molecular chaperone Hsp47, have noted differences in the response after photodynamic therapy and hyperthermia at both the transcriptional and translational levels. In the present study the levels of Hsp47 after exposure to two chemotherapeutic agents (bleomycin and mitomycin).