DOI QR코드

DOI QR Code

Metastatic Colorectal Cancer Treatment and Survival: the Experience of Major Public Hospitals in South Australia Over Three Decades

  • Roder, David (Centre for Population Health Research, University of South Australia) ;
  • Karapetis, Christos S (Department of Medical Oncology, Flinders Centre for Innovation in Cancer, Flinders University) ;
  • Wattchow, David (Department of Surgery, Flinders Medical Centre, Flinders University) ;
  • Moore, James (Colorectal Surgery, Royal Adelaide Hospital and University of Adelaide) ;
  • Singhal, Nimit (Medical Oncology, Royal Adelaide Hospital and University of Adelaide) ;
  • Joshi, Rohit (Medical Oncology, Lyell McEwin Hospital) ;
  • Keefe, Dorothy (Faculty of Health Sciences, University of Adelaide) ;
  • Fusco, Kellie (Centre for Population Health Research, University of South Australia) ;
  • Buranyi-Trevarton, Dianne (South Australian Health and Medical Research Institute) ;
  • Sharplin, Greg (Cancer Council South Australia) ;
  • Price, Timothy J (Medical Oncology, Queen Elizabeth Hospital Australia)
  • Published : 2015.09.02

Abstract

Background: Registry data from four major public hospitals indicate trends over three decades from 1980 to 2010 in treatment and survival from colorectal cancer with distant metastases at diagnosis (TNM stage IV). Materials and Methods: Kaplan-Meier product-limit estimates and Cox proportional hazards models for investigating disease-specific survival and multiple logistic regression analyses for indicating first-round treatment trends. Results: Two-year survivals increased from 10% for 1980-84 to 35% for 2005-10 diagnoses. Corresponding increases in five-year survivals were from 3% to 16%. Time-to-event risk of colorectal cancer death approximately halved (hazards ratio: 0.48 (0.40, 0.59) after adjusting for demographic factors, tumour differentiation, and primary sub-site. Survivals were not found to differ by place of residence, suggesting reasonable equity in service provision. About 74% of cases were treated surgically and this proportion increased over time. Proportions having systemic therapy and/or radiotherapy increased from 12% in 1980-84 to 61% for 2005-10. Radiotherapy was more common for rectal than colonic cases (39% vs 7% in 2005-10). Of the cases diagnosed in 2005-10 when less than 70 years of age, the percentage having radiotherapy and/or systemic therapy was 79% for colorectal, 74% for colon and 86% for rectum (&RS)) cancers. Corresponding proportions having: systemic therapies were 75%, 71% and 81% respectively; radiotherapy were 24%, 10% and 46% respectively; and surgery were 75%, 78% and 71% respectively. Based on survey data on uptake of offered therapies, it is likely that of these younger cases, 85% would have been offered systemic treatment and among rectum (&RS) cases, about 63% would have been offered radiotherapy. Conclusions: Pronounced increases in survivals from metastatic colorectal cancer have occurred, in keeping with improved systemic therapies and surgical interventions. Use of radiotherapy and/or systemic therapy has increased markedly and patterns of change accord with clinical guideline recommendations.

References

  1. Australian Bureau of Statistics (ABS) (1998). 1996 census of population and housing. Socio-economic indexes for areas, ABS, Canberra.
  2. Australian Institute of Health and Welfare (AIHW) (2012). Cancer survival and prevalence in Australia: period estimates from 1982 to 2010, Cancer Series No. 69. Cat. No. CAN 65, AIHW, Canberra.
  3. Australian Institute of Health and Welfare (AIHW) (2013), Australian cancer incidence and mortality (ACIM) books, AIHW, Canberra.
  4. Andre T, Boni C, Mounedji-Boudiaf L, et al (2004). Oxaplatin, fluorouracil, and leucovorin as adjuvant treatment for colon cancer. NEJM, 350, 2343-51. https://doi.org/10.1056/NEJMoa032709
  5. Armitage P, Berry G (eds.) (1987). Statistical methods in medical research, Blackwell Scientific Publications, Oxford.
  6. Australian Cancer Network Colorectal Cancer Guidelines Revision Committee (ACN) (2005). Guidelines for the prevention, early detection and management of colorectal cancer, Cancer Council Australia & Australian Cancer Network, Sydney.
  7. Australian Health Technology Advisory Committee (1997). Colorectal cancer screening, Commonwealth Department of Health and Family Services, Canberra.
  8. Beckmann KR, Bennett A, Young GP, et al (2014a). Treatment patterns among colorectal cancer patients in South Australia: a demonstration of the utility of population-based data linkage. J Eval Clin Pract, 20, 467-77. https://doi.org/10.1111/jep.12183
  9. Beckmann KR, Roder DM, Hiller JE, et al (2014b). Influence of mammographic screening on breast cancer incidence trends in South Australia. Asian Pac J Cancer Prev, 15, 3105-12. https://doi.org/10.7314/APJCP.2014.15.7.3105
  10. Bonett A, Roder D, Esterman A (1988). Cancer case-survival rates for South Australia: a comparison with US rates and a preliminary investigation of time trends. Med J Aust, 148, 556-9.
  11. Cancer Research UK (2014). Bowel cancer survival statistics. London: Cancer Research UK.
  12. Charakidis M, Price TJ, Beeke C, et al (2014). Survival improvements associated with access to biologic agents: Results from the South Australian (SA) metastatic colorectal (mCRC) Registry. J Clin Oncol, 32, suppl; abstr e17616.
  13. Cole SR, Tucker GR, Osborne JM, et al (2013). Shift to earlier stage at diagnosis as a consequence of the National Bowel Cancer Screening Program. Med J Aust, 198, 327-30. https://doi.org/10.5694/mja12.11357
  14. Coleman MP, Forman D, Bryant H, et al (2011). Cancer survival in Australia, Canada, Denmark, Norway, Sweden, and the UK, 1995-2007 (the International Cancer Benchmarking Partnership): an analysis of population-based cancer registry data. Lancet, 377, 127-38. https://doi.org/10.1016/S0140-6736(10)62231-3
  15. Dave RV, Pathak S, White AD, et al (2015). Outcome after liver resection in patients presenting with simultaneous hepatopulmonary colorectal metastases. Br J Surg, 102, 261-8. https://doi.org/10.1002/bjs.9737
  16. Department of Health & (AIHW) Australian Institute of Health and Welfare (2008). National Bowel Screening Program Monitoring Report, Canberra, AIHW, Cancer Series 44. Cat. no. 40
  17. Due SL, Wattchow DA, Sweeney JL, et al (2012). Colorectal cancer surgery 2000-2008: evaluation of a prospective database. ANZ J Surg, 82, 412-9. https://doi.org/10.1111/j.1445-2197.2012.06078.x
  18. Ferlay J, Soerjomataram I, Ervik M, et al (2013). Cancer incidence and mortality worldwide: IARC CancerBase No.11. Lyon, France: IARC .
  19. Hardcastle JD, Chamberlain JO, Robinson MH, et al (1996). Randomised controlled trial of faecal-occult-blood screening for colorectal cancer. Lancet, 348, 1472-7. https://doi.org/10.1016/S0140-6736(96)03386-7
  20. Hewitson P, Glasziou P, Watson E, et al (2008). Cochrane systematic review of colorectal cancer screening using the fecal occult blood test (hemoccult): an update. Am J Gastroenterol, 103, 1541-9. https://doi.org/10.1111/j.1572-0241.2008.01875.x
  21. Howlader N, Noone AM, Krapcho M, et al (eds.) (2015), SEER Cancer Statistics Review, 1975-2012, National Cancer Institute, Bethesda, MD.
  22. Jong KE, Smith DP, Yu XQ, et al (2004). Remoteness of residence and survival from cancer in New South Wales. Med J Aust, 180, 618-22.
  23. Jorgensen OD, Kronborg O, Fenger C (2002). A randomised study of screening for colorectal cancer using faecal occult blood testing: results after 13 years and seven biennial screening rounds. Gut, 50, 29-32. https://doi.org/10.1136/gut.50.1.29
  24. Kronborg O, Fenger C, Olsen J, et al (1996). Randomised study of screening for colorectal cancer with faecal-occult-blood test. Lancet, 348, 1467-71. https://doi.org/10.1016/S0140-6736(96)03430-7
  25. Kronborg O, Fenger C, Sondergaard O, et al (1987). Initial mass screening for colorectal cancer with fecal occult blood test. A prospective randomized study at Funen in Denmark. Scand J Gastroenterol, 22, 677-86. https://doi.org/10.3109/00365528709011142
  26. Kumar R, Jain K, Beeke C, et al (2013). A population-based study of metastatic colorectal cancer in individuals aged >= 80 years: findings from the South Australian clinical registry for metastatic colorectal cancer. Cancer, 119, 722-8. https://doi.org/10.1002/cncr.27802
  27. Lubowski DZ (2015). Rectal cancer: the evolving role of adjuvant radiotherapy. ANZ J Surg, 85, 99-100. https://doi.org/10.1111/ans.12916
  28. Mandel JS, Church TR, Bond JH, et al (2000). The effect of fecal occult-blood screening on the incidence of colorectal cancer. N Engl J Med, 343, 1603-7. https://doi.org/10.1056/NEJM200011303432203
  29. Martenson JA Jr, Willett CG, Sargent DJ, et al (2004). Phase III study of adjuvant chemotherapy and radiation therapy compared with chemotherapy alone in the surgical adjuvant treatment of colon cancer: results of intergroup protocol 0130. J Clin Oncol, 22, 3277-83. https://doi.org/10.1200/JCO.2004.01.029
  30. National Cancer Control Initiative (NCCI) (2000). The national colorectal cancer care survey. Australian clinical practice in 2000, Clinical Governance Unit, Melbourne.
  31. Neo EL, Beeke C, Price T, et al (2011). South Australian clinical registry for metastatic colorectal cancer. ANZ J Surg, 81, 352-7. https://doi.org/10.1111/j.1445-2197.2010.05589.x
  32. (NHMRC) National Health and Medical Research Council (1999), Clinical Practice Guidelines. Prevention, early detection and management of colorectal cancer, Commonwealth of Australia, Canberra.
  33. Padman S, Padbury R, Beeke C, et al (2013). Liver only metastatic disease in patients with metastatic colorectal cancer: impact of surgery and chemotherapy. Acta Oncol, 52, 1699-706. https://doi.org/10.3109/0284186X.2013.831473
  34. Price TJ, Beeke C, Ullah S, et al (2015). Does the primary site of colorectal cancer impact outcomes for patients with metastatic disease? Cancer, 121, 830-5. https://doi.org/10.1002/cncr.29129
  35. Price TJ, Segelov E, Burge M, et al (2014). Current opinion on optimal systemic treatment for metastatic colorectal cancer: outcome of the ACTG/AGITG expert meeting ECCO 2013. Expert Rev Anticancer Ther, 14, 1477-93. https://doi.org/10.1586/14737140.2014.949678
  36. Ries LAG, Miller BA, Hankey BF, et al (1994). SEER cancer statistics review, 1973-1991, National Cancer Institute, Bethesda, MD.
  37. Roder D, Karapetis CS, Wattchow D, et al (2015). Colorectal cancer treatment and survival: the experience of major public hospitals in South Australia over three decades. Asian Pac J Cancer Prev, 16, 2431-40. https://doi.org/10.7314/APJCP.2015.16.6.2431
  38. Roder D (2014). What roles should population-based cancer registries be playing in the 21st century? Reflections on the Asian Cancer Registry Forum, Bangkok, February 2014. Asian Pac J Cancer Prev, 15, 1895-6. https://doi.org/10.7314/APJCP.2014.15.5.1895
  39. Roder D, Buckley E (2015). Translation from clinical trials to routine practice: How to demonstrate community benefit. Asian Pac J Clin Oncol, [Epub ahead of print].
  40. Roder DM, Fong KM, Brown MP, et al (2014). Realising opportunities for evidence-based cancer service delivery and research: linking cancer registry and administrative data in Australia. Eur J Cancer Care (Engl), 23, 721-7. https://doi.org/10.1111/ecc.12242
  41. (SACR) South Australian Cancer Registry (1999). Epidemiology of cancer in South Australia. incidence, mortality, and survival 1977 to 1998. Incidence and mortality 1998, analysed by type and geographical location, Epidemiology Branch, Department of Health, Adelaide.
  42. (SACR) South Australian Cancer Registry (2007). Cancer in South Australia 2004, with incidence projections to 2007, Epidemiology Branch, Department of Health, Adelaide.
  43. Saltz LB, Douillard JY, Pirotta N, et al (2001). Irinotecan plus fluorouracil/leucovorin for metastatic colorectal cancer: a new survival standard. Oncologist, 6, 81-91. https://doi.org/10.1634/theoncologist.6-1-81
  44. Schmoll HJ, Van Cutsem E, Stein A, et al (2012). ESMO Consensus Guidelines for management of patients with colon and rectal cancer. A personalized approach to clinical decision making. Ann Oncol, 23, 2479-516. https://doi.org/10.1093/annonc/mds236
  45. Scholefield JH, Moss S, Sufi F, et al (2002). Effect of faecal occult blood screening on mortality from colorectal cancer: results from a randomised controlled trial. Gut, 50, 840-4. https://doi.org/10.1136/gut.50.6.840
  46. STATA (2012), Data analysis and statistical software, Version 12, StataCorp LP, College Station, Texas.
  47. Taheri N, Fazel A, Mahmoodzadeh H, et al (2014). Epidemiology of female reproductive cancers in Iran: results of the Gholestan Population-based Cancer Registry. Asian Pac J Cancer Prev, 15, 8779-82. https://doi.org/10.7314/APJCP.2014.15.20.8779
  48. U.S. Department of Health and Human Services (USDHHS). National Institutes of Health (NIH) (1990). NIH consensus development program: adjuvant therapy for patients with colon and rectum cancer, NIH consensus statement online. April 16-18 1990, 1-25.