Ju-Fang Shi1, Le Wang1, Jian-Chao Ran1,2, Hong Wang1, Cheng-Cheng Liu1, Hai-Zeng Zhang3, Lin Yang4, Su-Sheng Shi5, Li-Ming Jiang6, Jin-Hu Fan7, Yue-Ming Zhang8, Wei-Hu Wang9, Jian-Song Ren1, Lin Zhu2, Zhao-Xu Zheng3, Yong-Kun Sun4, Shuang-Mei Zou5, Jun Jiang6, Bo Chen9, Hong-Da Chen1, Guo-Xiang Liu10, Li Yang11, Yun-Chao Huang12, Lan-Wei Guo13, De-Bin Wang14, Yong-Zhen Zhang15, A-Yan Mao16, Jia-Lin Wang17, Ji-Yong Gong17, Dong-Hua Wei18, Wu-Qi Qiu16, Bing-Bing Song19, Kai Zhang20, Ni Li1, Eleonora Feletto21, Jie-Bin Lew21, You-Lin Qiao7, Wan-Qing Chen1, Min Dai1, Jie He22. 1. Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital (NCC/NCRCC/Cancer Hospital), Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS & PUMC), Beijing, China. 2. School of Public Health, Affiliated Cancer Hospital, Xinjiang Medical University, Xinjiang, China. 3. Department of Colorectal Surgery, NCC/NCRCC/Cancer Hospital, CAMS & PUMC, Beijing, China. 4. Department of Medical Oncology, NCC/NCRCC/Cancer Hospital, CAMS & PUMC, Beijing, China. 5. Department of Pathology, NCC/NCRCC/Cancer Hospital, CAMS & PUMC, Beijing, China. 6. Department of Imaging Diagnosis, NCC/NCRCC/Cancer Hospital, CAMS & PUMC, Beijing, China. 7. Department of Cancer Epidemiology, NCC/NCRCC/Cancer Hospital, CAMS & PUMC, Beijing, China. 8. Department of Endoscopy, NCC/NCRCC/Cancer Hospital, CAMS & PUMC, Beijing, China. 9. Department of Radiation Oncology, NCC/NCRCC/Cancer Hospital, CAMS & PUMC, Beijing, China. 10. School of Health Management, Harbin Medical University, Harbin, China. 11. School of Public Health, Guangxi Medical University, Nanning, China. 12. Department of Thoracic Surgery, Yunnan Cancer Hospital, Kunming, China. 13. Affiliated Cancer Hospital, Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China. 14. School of Health Management, Anhui Medical University, Hefei, China. 15. Department of Epidemiology, Shanxi Provincial Cancer Hospital, Taiyuan, China. 16. Division for Strategic Information Research in Public Health, Institute of Medical Information, CAMS & PUMC, Beijing, China. 17. Shandong Academy of Medical Sciences, Shandong Provincial Cancer Hospital Affiliated to Shandong University, Jinan, China. 18. Department of Cancer Prevention, Anhui Cancer Hospital, Hefei, China. 19. Heilongjiang Office for Cancer Control and Research, Affiliated Cancer Hospital of Harbin Medical University, Harbin, China. 20. Department of Physical Examination on Cancer, NCC/NCRCC/Cancer Hospital, CAMS & PUMC, Beijing, China. 21. Cancer Research Division, Cancer Council New South Wales, Woolloomooloo, New South Wales, Australia. 22. Department of Thoracic Surgery, NCC/NCRCC/Cancer Hospital, CAMS & PUMC, Beijing, China.
Abstract
BACKGROUND: Colorectal cancer (CRC) is the third most common cancer in China, however, publicly available, descriptive information on the clinical epidemiology of CRC is limited. METHODS: Patients diagnosed with primary CRC during 2005 through 2014 were sampled from 13 tertiary hospitals in 9 provinces across China. Data related to sociodemographic characteristics, the use of diagnostic technology, treatment adoption, and expenditure were extracted from individual medical records. RESULTS: In the full cohort of 8465 patients, the mean ± SD age at diagnosis was 59.3 ± 12.8 years, 57.2% were men, and 58.7% had rectal cancer. On average, 14.4% of patients were diagnosed with stage IV disease, and this proportion increased from 13.5% in 2005 to 20.5% in 2014 (P value for trend < .05). For diagnostic techniques, along with less use of x-rays (average, 81.6%; decreased from 90.0% to 65.7%), there were increases in the use of computed tomography (average, 70.4%; increased from 4.5% to 90.5%) and magnetic resonance imaging (average, 8.8%; increased from 0.1% to 20.4%) over the study period from 2005 to 2014. With regard to treatment, surgery alone was the most common (average, 50.1%), but its use decreased from 51.3% to 39.8% during 2005 through 2014; and the use of other treatments increased simultaneously, such as chemotherapy alone (average, 4.1%; increased from 4.1% to 11.9%). The average medical expenditure per patient was 66,291 Chinese Yuan (2014 value) and increased from 47,259 to 86,709 Chinese Yuan. CONCLUSIONS: The increasing proportion of late-stage diagnoses presents a challenge for CRC control in China. Changes in diagnostic and treatment options and increased expenditures are clearly illustrated in this study. Coupled with the recent introduction of screening initiatives, these data provide an understanding of changes over time and may form a benchmark for future related evaluations of CRC interventions in China.
BACKGROUND: Colorectal cancer (CRC) is the third most common cancer in China, however, publicly available, descriptive information on the clinical epidemiology of CRC is limited. METHODS: Patients diagnosed with primary CRC during 2005 through 2014 were sampled from 13 tertiary hospitals in 9 provinces across China. Data related to sociodemographic characteristics, the use of diagnostic technology, treatment adoption, and expenditure were extracted from individual medical records. RESULTS: In the full cohort of 8465 patients, the mean ± SD age at diagnosis was 59.3 ± 12.8 years, 57.2% were men, and 58.7% had rectal cancer. On average, 14.4% of patients were diagnosed with stage IV disease, and this proportion increased from 13.5% in 2005 to 20.5% in 2014 (P value for trend < .05). For diagnostic techniques, along with less use of x-rays (average, 81.6%; decreased from 90.0% to 65.7%), there were increases in the use of computed tomography (average, 70.4%; increased from 4.5% to 90.5%) and magnetic resonance imaging (average, 8.8%; increased from 0.1% to 20.4%) over the study period from 2005 to 2014. With regard to treatment, surgery alone was the most common (average, 50.1%), but its use decreased from 51.3% to 39.8% during 2005 through 2014; and the use of other treatments increased simultaneously, such as chemotherapy alone (average, 4.1%; increased from 4.1% to 11.9%). The average medical expenditure per patient was 66,291 Chinese Yuan (2014 value) and increased from 47,259 to 86,709 Chinese Yuan. CONCLUSIONS: The increasing proportion of late-stage diagnoses presents a challenge for CRC control in China. Changes in diagnostic and treatment options and increased expenditures are clearly illustrated in this study. Coupled with the recent introduction of screening initiatives, these data provide an understanding of changes over time and may form a benchmark for future related evaluations of CRC interventions in China.