New technology, rather than quality improvement, appears to be a powerful driver in the reconfiguration of surgical cancer centres in England…

According to a new study in The Lancet Oncology journal on 3 October 2017, of the 16 prostate cancer surgical centres that closed between 2010 and 2017, none had done so because of explicit evidence of poor quality care.

Robotic surgery preferred

Instead, patients often travelled to alternative centres that provided robotic surgery, leaving other centres that couldn’t attract the same level of patients faced with the threat of closure.

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Between 2010 and 2017, the number of robotic centres has more than tripled. This has occurred despite a lack of evidence of improved outcomes in terms of survival and side effects for robotic surgery compared to open surgery.

The study included data from 19 256 men in England who were diagnosed with prostate cancer and underwent radical prostatectomy between 2010 and 2014. It is the first analysis of the impact of patient choice and competition on the reorganisation of surgical cancer services in England

“NHS [National Health Service] choice and competition policy is based on the principle that patients will travel to centres they think will provide the best service. 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,” explains Dr Ajay Aggarwal, London School of Hygiene & Tropical Medicine, UK.

New and unproven technologies

“NHS hospitals are subsequently investing millions of pounds in new and sometimes unproven technologies which have a direct impact on the type of care patients receive, but also the configuration of services as a whole,” adds Dr Aggarval.

“Similar patterns have been observed in other health-care markets such as the United States. Rapid adoption of high technology therapies is not unique to prostate cancer, and further research should look at other types of cancer where new types of treatment are increasingly available as well,” says Dr Aggarwal.

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