Multiple cancer site comparison of adjusted survival by hospital of treatment: an East Anglian study.

We performed a preliminary investigation into which hospitals would benefit from investment and development, and which should have services restricted, with respect to the implementation of the Calman-Hine strategy of specialist cancer care. A retrospective study approach was used implementing uniform definitions for colon, rectal, breast, melanoma, bladder and ovarian cancers. A total of 14 527 cases registered by the East Anglian cancer registry and diagnosed between 1989 and 1993 were included. The cases were analysed in two age groups (< 75, 75+ years) and two hospital groups: group 1, those treated at hospitals with radiotherapy and oncology departments; group 2, other district general hospitals. Adjusted hazard ratios derived from Cox's proportional hazards model and adjusted conditional survival curves were presented. We found that after adjustment for age, sex and tumour stage at diagnosis, survival up to 5 years after diagnosis was usually worse in group 2 hospitals and significantly so for patients aged < 75 years with breast, ovarian and rectal tumours. Hospital workload produced little significant effect independently from hospital group. Analysing the selected cancer sites using uniform definitions and consistent staging supports the view that the strategy proposed in the Calman-Hine report is likely to be beneficial, but particular priority for change should be given to younger patients with breast, ovarian and rectal tumours.