BACKGROUND: Large international differences in colorectal cancer survival exist, even between countries with similar healthcare. We investigate the extent to which stage at diagnosis explains these differences. METHODS: Data from population-based cancer registries in Australia, Canada, Denmark, Norway, Sweden and the UK were analysed for 313 852 patients diagnosed with colon or rectal cancer during 2000-2007. We compared the distributions of stage at diagnosis. We estimated both stage-specific net survival and the excess hazard of death up to three years after diagnosis, using flexible parametric models on the log-cumulative excess hazard scale. RESULTS: International differences in colon and rectal cancer stage distributions were wide: Denmark showed a distribution skewed towards later-stage disease, while Australia, Norway and the UK showed high proportions of 'regional' disease. One-year colon cancer survival was 67% in the UK and ranged between 71% (Denmark) and 80% (Australia and Sweden) elsewhere. For rectal cancer, one-year survival was also low in the UK (75%), compared to 79% in Denmark and 82-84% elsewhere. International survival differences were also evident for each stage of disease, with the UK showing consistently lowest survival at one and three years. CONCLUSION: Differences in stage at diagnosis partly explain international differences in colorectal cancer survival, with a more adverse stage distribution contributing to comparatively low survival in Denmark. Differences in stage distribution could arise because of differences in diagnostic delay and awareness of symptoms, or in the thoroughness of staging procedures. Nevertheless, survival differences also exist for each stage of disease, suggesting unequal access to optimal treatment, particularly in the UK.
BACKGROUND: Large international differences in colorectal cancer survival exist, even between countries with similar healthcare. We investigate the extent to which stage at diagnosis explains these differences. METHODS: Data from population-based cancer registries in Australia, Canada, Denmark, Norway, Sweden and the UK were analysed for 313 852 patients diagnosed with colon or rectal cancer during 2000-2007. We compared the distributions of stage at diagnosis. We estimated both stage-specific net survival and the excess hazard of death up to three years after diagnosis, using flexible parametric models on the log-cumulative excess hazard scale. RESULTS: International differences in colon and rectal cancer stage distributions were wide: Denmark showed a distribution skewed towards later-stage disease, while Australia, Norway and the UK showed high proportions of 'regional' disease. One-year colon cancer survival was 67% in the UK and ranged between 71% (Denmark) and 80% (Australia and Sweden) elsewhere. For rectal cancer, one-year survival was also low in the UK (75%), compared to 79% in Denmark and 82-84% elsewhere. International survival differences were also evident for each stage of disease, with the UK showing consistently lowest survival at one and three years. CONCLUSION: Differences in stage at diagnosis partly explain international differences in colorectal cancer survival, with a more adverse stage distribution contributing to comparatively low survival in Denmark. Differences in stage distribution could arise because of differences in diagnostic delay and awareness of symptoms, or in the thoroughness of staging procedures. Nevertheless, survival differences also exist for each stage of disease, suggesting unequal access to optimal treatment, particularly in the UK.
Authors: Brian D Nicholson; David Mant; Richard D Neal; Nigel Hart; Willie Hamilton; Bethany Shinkins; Greg Rubin; Peter W Rose Journal: Br J Gen Pract Date: 2016-01-06 Impact factor: 5.386
Authors: Brian D Nicholson; Matthew Thompson; Christopher P Price; Carl Heneghan; Annette Plüddemann Journal: Br J Gen Pract Date: 2015-03 Impact factor: 5.386
Authors: Richard Baird; Ian Banks; David Cameron; John Chester; Helena Earl; Mark Flannagan; Adam Januszewski; Richard Kennedy; Sarah Payne; Emlyn Samuel; Hannah Taylor; Roshan Agarwal; Samreen Ahmed; Caroline Archer; Ruth Board; Judith Carser; Ellen Copson; David Cunningham; Rob Coleman; Adam Dangoor; Graham Dark; Diana Eccles; Chris Gallagher; Adam Glaser; Richard Griffiths; Geoff Hall; Marcia Hall; Danielle Harari; Michael Hawkins; Mark Hill; Peter Johnson; Alison Jones; Tania Kalsi; Eleni Karapanagiotou; Zoe Kemp; Janine Mansi; Ernie Marshall; Alex Mitchell; Maung Moe; Caroline Michie; Richard Neal; Tom Newsom-Davis; Alison Norton; Richard Osborne; Gargi Patel; John Radford; Alistair Ring; Emily Shaw; Rod Skinner; Dan Stark; Sam Turnbull; Galina Velikova; Jeff White; Alison Young; Johnathan Joffe; Peter Selby Journal: Ecancermedicalscience Date: 2016-01-05
Authors: Petra G Boelens; Claire Taylor; Geoffrey Henning; Perla J Marang-van de Mheen; Eloy Espin; Theo Wiggers; Jola Gore-Booth; Barbara Moss; Vincenzo Valentini; Cornelis J H van de Velde Journal: Patient Date: 2014 Impact factor: 3.883
Authors: Claudia Allemani; Tomohiro Matsuda; Veronica Di Carlo; Rhea Harewood; Melissa Matz; Maja Nikšić; Audrey Bonaventure; Mikhail Valkov; Christopher J Johnson; Jacques Estève; Olufemi J Ogunbiyi; Gulnar Azevedo E Silva; Wan-Qing Chen; Sultan Eser; Gerda Engholm; Charles A Stiller; Alain Monnereau; Ryan R Woods; Otto Visser; Gek Hsiang Lim; Joanne Aitken; Hannah K Weir; Michel P Coleman Journal: Lancet Date: 2018-01-31 Impact factor: 79.321
Authors: Henry Jensen; Marie Louise Tørring; Morten Fenger-Grøn; Frede Olesen; Jens Overgaard; Peter Vedsted Journal: Br J Gen Pract Date: 2016-03-29 Impact factor: 5.386