Colorectal cancer survival in the USA and Europe: a CONCORD high-resolution study.

OBJECTIVES: To assess the extent to which stage at diagnosis and adherence to treatment guidelines may explain the persistent differences in colorectal cancer survival between the USA and Europe. DESIGN: A high-resolution study using detailed clinical data on Dukes' stage, diagnostic procedures, treatment and follow-up, collected directly from medical records by trained abstractors under a single protocol, with standardised quality control and central statistical analysis. SETTING AND PARTICIPANTS: 21 population-based registries in seven US states and nine European countries provided data for random samples comprising 12 523 adults (15-99 years) diagnosed with colorectal cancer during 1996-1998. OUTCOME MEASURES: Logistic regression models were used to compare adherence to 'standard care' in the USA and Europe. Net survival and excess risk of death were estimated with flexible parametric models. RESULTS: The proportion of Dukes' A and B tumours was similar in the USA and Europe, while that of Dukes' C was more frequent in the USA (38% vs 21%) and of Dukes' D more frequent in Europe (22% vs 10%). Resection with curative intent was more frequent in the USA (85% vs 75%). Elderly patients (75-99 years) were 70-90% less likely to receive radiotherapy and chemotherapy. Age-standardised 5-year net survival was similar in the USA (58%) and Northern and Western Europe (54-56%) and lowest in Eastern Europe (42%). The mean excess hazard up to 5 years after diagnosis was highest in Eastern Europe, especially among elderly patients and those with Dukes' D tumours. CONCLUSIONS: The wide differences in colorectal cancer survival between Europe and the USA in the late 1990s are probably attributable to earlier stage and more extensive use of surgery and adjuvant treatment in the USA. Elderly patients with colorectal cancer received surgery, chemotherapy or radiotherapy less often than younger patients, despite evidence that they could also have benefited.

Journal Article;

Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Cancer Prevention and Control, Cancer Surveillance Branch, Atlanta, GA; Louisiana Tumor Registry, School of Public Health, Louisiana State University, New Orleans, LA (cooperative agreement #U58/CCU 62(306); CDC/NPCR contractor. Atlanta, GA; New York State Cancer Registry, New York State Department of Health, Albany, NY (cooperative agreement #U58/CCU 220322); Colorado Central Cancer Registry, Colorado Department of Public Health and Environment, Denver, CO (cooperative agreement #U58/CCU 820326); Illinois State Cancer Registry, Illinois Department of Public Health, Springfield, IL (cooperative agreement #U58/CCU 520378); South Carolina Central Cancer Registry, Columbia; SC (cooperative agreement #U58/CCU 420312); California Cancer Registry, Sacramento, CA (cooperative, agreement #U58/CCU 920352); Rhode Island Cancer Registry, Rhode Island Department of Health, Providence, RI (cooperative agreement #U58/CCU 520378); University of Kentucky, Lexington KY (UKRF 3049024672-12-568). Support was also obtained from the Health Department of the Navarra Government, Spain (research grant 79/2000). The participation of Estonia was partly supported by the Estonian Ministry of Education and Research (SF0940026s07).