6533b7defe1ef96bd127690d
RESEARCH PRODUCT
Colorectal cancer survival in the USA and Europe: a CONCORD high-resolution study
Rosemary D. CressEva ArdanazMilena SantRiccardo CapocacciaMarina VercelliJean FaivreGiovanna TagliabueXiao-cheng WuTimo HakulinenGemma GattaStanisław GóźdźTiefu ShenPaolo BailiClaudio LombardoMichel ColemanHannah K. WeirClaudia AllemaniChakameh Safaei DibaSusan BolickMaja Primic-žakeljMaria J. SchymuraHolly J. WolfCôme LepageRosario TuminoJohn P FultonMarloes ElferinkJadwiga RachtanMaría José SánchezLisa C. RichardsonTiiu AareleidBernard RachetMagdalena Bielska-lasotaJaume Galceransubject
Gerontologymedicine.medical_specialtyEpidemiologyColorectal cancermedicine.medical_treatmentPopulationSalud Pública:Disciplines and Occupations::Health Occupations::Medicine::Public Health [Medical Subject Headings]Logistic regressionInternal medicineEpidemiologyNeoplasias Colorrectalesmedicine1724Epidemiología1506Stage (cooking)educationeducation.field_of_study1695business.industryResearchMedical recordStatistics & Research MethodsAbsolute risk reduction:Diseases::Neoplasms::Neoplasms by Site::Digestive System Neoplasms::Gastrointestinal Neoplasms::Intestinal Neoplasms::Colorectal Neoplasms [Medical Subject Headings]General Medicinemedicine.disease1692Radiation therapyPublic Healthcolorectal cancer survival:Disciplines and Occupations::Health Occupations::Medicine::Public Health::Epidemiology [Medical Subject Headings]1717businessdescription
Journal Article; OBJECTIVES: To assess the extent to which stage at diagnosis and adherence to treatment guidelines may explain the persistent differences in colorectal cancer survival between the USA and Europe. DESIGN: A high-resolution study using detailed clinical data on Dukes' stage, diagnostic procedures, treatment and follow-up, collected directly from medical records by trained abstractors under a single protocol, with standardised quality control and central statistical analysis. SETTING AND PARTICIPANTS: 21 population-based registries in seven US states and nine European countries provided data for random samples comprising 12 523 adults (15-99 years) diagnosed with colorectal cancer during 1996-1998. OUTCOME MEASURES: Logistic regression models were used to compare adherence to 'standard care' in the USA and Europe. Net survival and excess risk of death were estimated with flexible parametric models. RESULTS: The proportion of Dukes' A and B tumours was similar in the USA and Europe, while that of Dukes' C was more frequent in the USA (38% vs 21%) and of Dukes' D more frequent in Europe (22% vs 10%). Resection with curative intent was more frequent in the USA (85% vs 75%). Elderly patients (75-99 years) were 70-90% less likely to receive radiotherapy and chemotherapy. Age-standardised 5-year net survival was similar in the USA (58%) and Northern and Western Europe (54-56%) and lowest in Eastern Europe (42%). The mean excess hazard up to 5 years after diagnosis was highest in Eastern Europe, especially among elderly patients and those with Dukes' D tumours. CONCLUSIONS: The wide differences in colorectal cancer survival between Europe and the USA in the late 1990s are probably attributable to earlier stage and more extensive use of surgery and adjuvant treatment in the USA. Elderly patients with colorectal cancer received surgery, chemotherapy or radiotherapy less often than younger patients, despite evidence that they could also have benefited. Yes
| year | journal | country | edition | language |
|---|---|---|---|---|
| 2013-09-10 | BMJ Open |