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Inequity in colorectal cancer treatment and outcomes: a population-based study.

Carsin AE, Sharp L, Cronin-Fenton DP, Céilleachair AO, Comber H - Br. J. Cancer (2008)

Bottom Line: Patient-related factors were significantly associated with treatment receipt.Chemotherapy was significantly associated with lower mortality for stage III, but not stage II, colon cancer.Improving treatment availability overall, and equity, has the potential to reduce mortality.

View Article: PubMed Central - PubMed

Affiliation: National Cancer Registry, Ireland, Building 6800, Cork Airport Business Park, Kinsale Road, Cork, Ireland.

ABSTRACT
Several uncertainties surround optimal management of colorectal cancer. We investigated treatment patterns and factors influencing treatment receipt and mortality in routine clinical practice. We included 15 249 individuals, recorded by the National Cancer Registry (Ireland), with primary invasive colon or rectal tumours, diagnosed during 1994-2002. Logistic regression and Cox proportional hazards were used to determine factors associated with treatment receipt within 1 year of diagnosis and with mortality, respectively. A total of 78% had colorectal resection, 31% chemotherapy, and 13% radiotherapy (4% colon; 28% rectum). Half of stage IV patients underwent resection. Chemotherapy and radiotherapy use increased by at least 10% per annum. There was a notable increase in pre-operative radiotherapy from 2000 onwards. Patient-related factors were significantly associated with treatment receipt. Patients who were male, older, not married, or smokers had significantly higher risks of death. Chemotherapy was significantly associated with lower mortality for stage III, but not stage II, colon cancer. For rectal cancer, pre-operative radiotherapy was associated with reduced mortality. Surgery and chemotherapy were associated with longer survival for stage IV patients. The observed inequities in treatment and outcomes suggest that there is potential for further dissemination of therapies in routine practice. Improving treatment availability overall, and equity, has the potential to reduce mortality.

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Related in: MedlinePlus

Trends in treatment receipt among colorectal cancer patients, 1994–2002: observed frequencies plus jointpoint regression lines. (A) chemotherapy (% of all patients), (B) radiotherapy (% of all patients), and (C) pre and postoperative therapy (% of rectal cancers).
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fig1: Trends in treatment receipt among colorectal cancer patients, 1994–2002: observed frequencies plus jointpoint regression lines. (A) chemotherapy (% of all patients), (B) radiotherapy (% of all patients), and (C) pre and postoperative therapy (% of rectal cancers).

Mentions: From 1994 to 2002, there was no change in the proportion undergoing surgery (data not shown). Chemotherapy use increased significantly for both colon and rectal cancer (estimated annual percentage change (EAPC)=+9.6%, 95% CI +8.4, +10.8%; Figure 1A), although the increase slowed down for colon cancer patients in 2000–02. The growth in chemotherapy was evident for all disease stages. Use of radiotherapy for rectal cancer increased overall (EAPC=+12.3%, 95% CI +10.3, +14.2%; Figure 1B), particularly for those with stage I disease (EAPC=+23.0%, 95% CI +16.0, +30.3%). The upward trend was most pronounced for pre-operative use (EAPC=+34.3%, 95% CI +24.7, +44.6%; Figure 1C), particularly from 2000 onwards.


Inequity in colorectal cancer treatment and outcomes: a population-based study.

Carsin AE, Sharp L, Cronin-Fenton DP, Céilleachair AO, Comber H - Br. J. Cancer (2008)

Trends in treatment receipt among colorectal cancer patients, 1994–2002: observed frequencies plus jointpoint regression lines. (A) chemotherapy (% of all patients), (B) radiotherapy (% of all patients), and (C) pre and postoperative therapy (% of rectal cancers).
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2480963&req=5

fig1: Trends in treatment receipt among colorectal cancer patients, 1994–2002: observed frequencies plus jointpoint regression lines. (A) chemotherapy (% of all patients), (B) radiotherapy (% of all patients), and (C) pre and postoperative therapy (% of rectal cancers).
Mentions: From 1994 to 2002, there was no change in the proportion undergoing surgery (data not shown). Chemotherapy use increased significantly for both colon and rectal cancer (estimated annual percentage change (EAPC)=+9.6%, 95% CI +8.4, +10.8%; Figure 1A), although the increase slowed down for colon cancer patients in 2000–02. The growth in chemotherapy was evident for all disease stages. Use of radiotherapy for rectal cancer increased overall (EAPC=+12.3%, 95% CI +10.3, +14.2%; Figure 1B), particularly for those with stage I disease (EAPC=+23.0%, 95% CI +16.0, +30.3%). The upward trend was most pronounced for pre-operative use (EAPC=+34.3%, 95% CI +24.7, +44.6%; Figure 1C), particularly from 2000 onwards.

Bottom Line: Patient-related factors were significantly associated with treatment receipt.Chemotherapy was significantly associated with lower mortality for stage III, but not stage II, colon cancer.Improving treatment availability overall, and equity, has the potential to reduce mortality.

View Article: PubMed Central - PubMed

Affiliation: National Cancer Registry, Ireland, Building 6800, Cork Airport Business Park, Kinsale Road, Cork, Ireland.

ABSTRACT
Several uncertainties surround optimal management of colorectal cancer. We investigated treatment patterns and factors influencing treatment receipt and mortality in routine clinical practice. We included 15 249 individuals, recorded by the National Cancer Registry (Ireland), with primary invasive colon or rectal tumours, diagnosed during 1994-2002. Logistic regression and Cox proportional hazards were used to determine factors associated with treatment receipt within 1 year of diagnosis and with mortality, respectively. A total of 78% had colorectal resection, 31% chemotherapy, and 13% radiotherapy (4% colon; 28% rectum). Half of stage IV patients underwent resection. Chemotherapy and radiotherapy use increased by at least 10% per annum. There was a notable increase in pre-operative radiotherapy from 2000 onwards. Patient-related factors were significantly associated with treatment receipt. Patients who were male, older, not married, or smokers had significantly higher risks of death. Chemotherapy was significantly associated with lower mortality for stage III, but not stage II, colon cancer. For rectal cancer, pre-operative radiotherapy was associated with reduced mortality. Surgery and chemotherapy were associated with longer survival for stage IV patients. The observed inequities in treatment and outcomes suggest that there is potential for further dissemination of therapies in routine practice. Improving treatment availability overall, and equity, has the potential to reduce mortality.

Show MeSH
Related in: MedlinePlus