Colorectal cancer survival in the USA and Europe: a CONCORD high-resolution study

Details

• Alternative Title:
  BMJ Open
• Personal Author:
  Allemani, Claudia ; Rachet, Bernard ; Weir, Hannah K ; Richardson, Lisa C ; Lepage, Côme ; Faivre, Jean ; Gatta, Gemma ; Capocaccia, Riccardo ; Sant, Milena ; Baili, Paolo ; Lombardo, Claudio ; Aareleid, Tiiu ; Ardanaz, Eva ; Bielska-Lasota, Magdalena ; Bolick, Susan ; Cress, Rosemary ; Elferink, Marloes ; Fulton, John P ; Galceran, Jaume ; Góźdź, Stanisław ; Hakulinen, Timo ; Primic-Žakelj, Maja ; Rachtan, Jadwiga ; Diba, Chakameh Safaei ; Sánchez, Maria-José ; Schymura, Maria J ; Shen, Tiefu ; Tagliabue, Giovanna ; Tumino, Rosario ; Vercelli, Marina ; Wolf, Holly J ; Wu, Xiao-Cheng ; Coleman, Michel P
• Description:
  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.
  
  
• Subjects:
  Epidemiology Public Health Statistics & Research Methods
• Source:
  BMJ Open. 2013; 3(9).
• Document Type:
  Journal Article
• Funding:
  11700/Cancer Research UK/United Kingdom
• Name as Subject:
  Europe ; United States
• Volume:
  3
• Issue:
  9
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:35bb25e62320153b7536262da47201b62ef028f1249b2b6a67e69154a74da0f4
• Download URL:
  https://stacks.cdc.gov/view/cdc/21142/cdc_21142_DS1.pdf
• File Type:
  [PDF - 1.23 MB ]