New technologies attract patients with prostate cancer to treatment centres, study findsBMJ 2017; 359 doi: https://doi.org/10.1136/bmj.j4621 (Published 05 October 2017) Cite this as: BMJ 2017;359:j4621
The availability of new technologies such as robotic systems is attracting patients to cancer surgery centres rather than evidence of quality of care, a study of patients undergoing prostate cancer surgery in England has found.1
Several countries, including the UK, have introduced policies that allow patients to choose a specific healthcare provider, with the aim of improving quality of care. Previous research has shown that patients are willing to travel to centres other than their nearest hospital for cancer surgery, but information on how they make this choice has been limited.
Researchers mapped all 19 256 patients in England undergoing radical prostatectomy at NHS centres from 1 January 2010 to 31 December 2014. They looked at where the patients chose to have their surgery, the factors affecting their choice, and the impact this had on closure of radical prostatectomy services.
The results, reported in the Lancet Oncology,1 showed that just over one third of the 65 radical prostatectomy centres (23; 35%) open at the start of the study period had a statistically significant net gain of patients during 2010-14, with some centres performing an additional 400-500 procedures as a result of patients travelling there. Of these 23 cancer surgery services, 10 (40%) were established robotic centres.
Over half of the prostatectomy centres (37; 57%) showed a significant net loss of patients during the study period. Only two of these (5%) were established robotic centres, and 10 (27%) closed their radical prostatectomy service during 2010-14.
The radical prostatectomy centres that closed were more likely to be in areas with stronger competition, where patients had a choice of centres within a 60 minute drive.
“In the absence of data on outcomes, the mobility of patients has been driven by factors such as the availability of advanced surgical technology and the reputation of individual hospitals and clinicians,” said the researchers, led by Ajay Aggarwal, of the London School of Hygiene and Tropical Medicine.
“NHS choice and competition policy is based on the principle that patients will travel to centres they think will provide the best service,” said Aggarwal. “Closures were never intended to result from this, but the large number of patients deciding to receive treatment elsewhere meant some centres faced the risk of closures as they were no longer performing a sufficient number of procedures to sustain their service.”
The researchers concluded that competitive factors had contributed to large scale investment in robotic surgery equipment without evidence of superior outcomes and had contributed to the closure of cancer surgery units.
They warned, “If quality performance and outcome indicators are not available to guide patient choice, these policies could threaten health services’ ability to deliver equitable and affordable cancer care.”
The study was funded by the National Institute for Health Research.