Surgical treatment and survival from colorectal cancer in Denmark, England, Norway, and Sweden: a population-based study

Abstract

SummaryBackgroundSurvival from colorectal cancer has been shown to be lower in Denmark and England than in comparable high-income countries. We used data from national colorectal cancer registries to assess whether differences in the proportion of patients receiving resectional surgery could contribute to international differences in colorectal cancer survival.MethodsIn this population-based study, we collected data from all patients aged 18–99 years diagnosed with primary, invasive, colorectal adenocarcinoma from Jan 1, 2010, to Dec 31, 2012, in Denmark, England, Norway, and Sweden, from national colorectal cancer registries. We estimated age-standardised net survival using multivariable modelling, and we compared the proportion of patients receiving resectional surgery by stage and age. We used logistic regression to predict the resectional surgery status patients would have had if they had been treated as in the best performing country, given their individual characteristics.FindingsWe extracted registry data for 139 457 adult patients with invasive colorectal adenocarcinoma: 12 958 patients in Denmark, 97 466 in England, 11 450 in Norway, and 17 583 in Sweden. 3-year colon cancer survival was lower in England (63·9%, 95% CI 63·5–64·3) and Denmark (65·7%, 64·7–66·8) than in Norway (69·5%, 68·4–70·5) and Sweden (72·1%, 71·2–73·0). Rectal cancer survival was lower in England (69·7%, 69·1–70·3) than in the other three countries (Denmark 72·5%, 71·1–74·0; Sweden 74·1%, 72·7–75·4; and Norway 75·0%, 73·1–76·8). We found no significant differences in survival for patients with stage I disease in any of the four countries. 3-year survival after stage II or III rectal cancer and stage IV colon cancer was consistently lower in England (stage II rectal cancer 86·4%, 95% CI 85·0–87·6; stage III rectal cancer 75·5%, 74·2–76·7; and stage IV colon cancer 20·5%, 19·9–21·1) than in Norway (94·1%, 91·5–96·0; 83·4%, 80·1–86·1; and 33·0%, 31·0–35·1) and Sweden (92·9%, 90·8–94·6; 80·6%, 78·2–82·7; and 23·7%, 22·0–25·3). 3-year survival after stage II rectal cancer and stage IV colon cancer was also lower in England than in Denmark (stage II rectal cancer 91·2%, 88·8–93·1; and stage IV colon cancer 23·5%, 21·9–25·1). The total proportion of patients treated with resectional surgery ranged from 47 803 (68·4%) of 69 867 patients in England to 9582 (81·3%) of 11 786 in Sweden for colon cancer, and from 16 544 (59·9%) of 27 599 in England to 4106 (70·8%) of 5797 in Sweden for rectal cancer. This range was widest for patients older than 75 years (colon cancer 19 078 [59·7%] of 31 946 patients in England to 4429 [80·9%] of 5474 in Sweden; rectal cancer 4663 [45·7%] of 10 195 in England to 1342 [61·9%] of 2169 in Sweden), and the proportion of patients treated with resectional surgery was consistently lowest in England. The age gradient of the decline in the proportion of patients treated with resectional surgery was steeper in England than in the other three countries in all stage categories. In the hypothetical scenario where all patient...

Nationwide in-hospital mortality rate following rectal resection for rectal cancer according to annual hospital volume in Germany

“…In the UK, the Calman–Hine Report recommended similar strategic improvements to cancer services. The subsequent centralization and specialization improved the short‐ and long‐term outcomes of affected patients and narrowed the gap between patients with rectal cancer in the UK and those in continental Europe. Similar observations have been made for several other centralization programmes.…”

Colon and rectal cancer survival in seven high-income countries 2010–2014: variation by age and stage at diagnosis (the ICBP SURVMARK-2 project)

“…For example, the proportion of colon cancer patients receiving surgical treatment ranged from 68.4% in England to 81.3% in Sweden, and from 59.9% to 70.8% for rectal cancer, respectively. [34] The variation is even larger for CRC patients older than 75 years; for example for colon cancer patients in England this was 59.7% as compared to 80.9% in Sweden. [34] In addition to surgery, systemic therapy is an important treatment modality for regional CRC.…”

“…[34] The variation is even larger for CRC patients older than 75 years; for example for colon cancer patients in England this was 59.7% as compared to 80.9% in Sweden. [34] In addition to surgery, systemic therapy is an important treatment modality for regional CRC. [35] Studies have shown large variations in the use of adjuvant chemotherapy [36] and pre-operative radiotherapy [37] across countries.…”

Tumour regression after radiotherapy for rectal cancer – Results from the randomised Stockholm III trial

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