Inequity in colorectal cancer treatment and outcomes: a population-based study

Abstract

Several uncertainties surround optimal management of colorectal cancer. We investigated treatment patterns and factors influencing treatment receipt and mortality in routine clinical practice. We included 15 249 individuals, recorded by the National Cancer Registry (Ireland), with primary invasive colon or rectal tumours, diagnosed during 1994 -2002. Logistic regression and Cox proportional hazards were used to determine factors associated with treatment receipt within 1 year of diagnosis and with mortality, respectively. A total of 78% had colorectal resection, 31% chemotherapy, and 13% radiotherapy (4% colon; 28% rectum). Half of stage IV patients underwent resection. Chemotherapy and radiotherapy use increased by at least 10% per annum. There was a notable increase in pre-operative radiotherapy from 2000 onwards. Patient-related factors were significantly associated with treatment receipt. Patients who were male, older, not married, or smokers had significantly higher risks of death. Chemotherapy was significantly associated with lower mortality for stage III, but not stage II, colon cancer. For rectal cancer, pre-operative radiotherapy was associated with reduced mortality. Surgery and chemotherapy were associated with longer survival for stage IV patients. The observed inequities in treatment and outcomes suggest that there is potential for further dissemination of therapies in routine practice. Improving treatment availability overall, and equity, has the potential to reduce mortality.

Cost of care for colorectal cancer in Ireland: a health care payer perspective

“…In addition, in European countries, rates of utilisation of chemotherapy in colorectal cancer have increased substantially over time [54,55]. In Ireland, in 1994, 20% of patients received chemotherapy rising to more than 35% of colon cancer patients and almost 50% of rectal cancer patients by 2002 [56]. Both of these trends have increased the costs of treatment substantially over the past decade and provide another explanation for the higher treatment costs in our study than in some older European studies.…”

Inequity in Access to Guideline-Recommended Colorectal Cancer Treatment in Nova Scotia, Canada

“…Lower rates of access to chemotherapy and radiotherapy with increasing age have been well documented in the literature. Even after controlling for health status, older individuals were significantly less likely to receive adjuvant treatment (Cree et al 2009;Carsin et al 2008;Potosky et al 2002;golfinopoulos 2006;Newcomb and Carbone 1993). Previous studies have demonstrated that older patients were less likely to be given chemotherapy and radiotherapy as treatment options by physicians and less likely to be referred to medical and radiation oncologists (Newcomb and Carbone 1993;Weeks 1994), despite evidence of the effectiveness of these treatments in elderly patients (zachariah et al 1997;Pignon et al 1997).…”

Smoking at Diagnosis Is an Independent Prognostic Factor for Cancer-Specific Survival in Head and Neck Cancer: Findings from a Large, Population-Based Study

“…67-69). Various studies, including several from Ireland for other cancers, suggest that married patients are more likely to receive cancer-directed therapy than unmarried patients (67,(70)(71)(72)(73)(74). The explanations for these findings remain uncertain, but possibilities may include more active intervention by patients' families in treatment planning and/or more readily available social support during and after treatment among married patients.…”