High hospital research participation and improved colorectal cancer survival outcomes: a population-based study

Objective: In 2001, the National Institute for Health Research (NIHR) Cancer Research Network (NCRN) was established, leading to a rapid increase in clinical research activity across the English NHS. Using colorectal cancer (CRC) as an example, we test the hypothesis that high, sustained hospital-level participation in interventional clinical trials improves outcomes for all CRC patients managed in those research-intensive hospitals.

Design: Data for patients diagnosed with CRC in England in 2001-2008 (n=209,968) were linked with data on accrual to NCRN CRC studies (n=30,998). Hospital Trusts were categorised by the proportion of patients accrued to interventional studies annually. Multivariable models investigated the relationship between 30-day post-operative mortality and five-year survival and the level and duration of study participation.

Results: Most of the Trusts achieving high participation were district general hospitals and the effects were not limited to cancer “centres of excellence”, although such centres do make substantial contributions. Patients treated in Trusts with high research participation (≥16%) in their year of diagnosis had lower post-operative mortality (p<0.001) and improved survival (p<0.001) after adjustment for casemix and hospital-level variables. The effects increased with sustained research participation, with a reduction in post-operative mortality of 1.5% (6.5% to 5%, p<2.2*10-6) and an improvement in survival (p<10 19; 5-year difference: 3.8% (41.0% to 44.8%)) comparing high participation for ≥4 years with 0 years.

Conclusion: There is a strong independent association between survival and participation in interventional clinical studies for all CRC patients treated in the hospital, not only study participants. Improvement precedes and increases with the level and years of sustained participation.